Unusual bilateral ureter strangulation by fibrous tissue after perineal hernia repair in a dog

Abstract

A 10-year-old castrated male cross-breed dog was referred for the repair of perineal hernia with bladder retroflexion and a mass lesion in the hernial sac. Surgical treatment was performed and the mass was identified as degenerated adipose tissue that was suspected to be derived from the omentum. The hernial contents were reduced without difficulty, and the dog exhibited a normal recovery. Two days after surgery, the dog suddenly exhibited anorexia and azotemia. Exploratory laparotomy was performed, which showed the dilation of both ureters with discoloration of the bladder serosa and strangulation of the urinary bladder neck. Careful inspection confirmed that a fibrous band, which was connected to the mass-like degenerated adipose tissue, had caused the strangulation. Two days after removal of these tissues, the dog recovered, with normal findings on blood biochemical analysis. The condition described in this report is an uncommon complication of perineal hernia repair. The findings suggest that degenerative fat tissue should be resected during perineal hernia repair in dogs, in order to prevent possible bladder strangulation after surgery.

Keywords: Adipose tissue; Dog; Hydronephrosis; Hydroureter; Perineal hernia.

Fig. 1

Ultrasound findings for the right kidney on the first day of referral of a dog with perineal hernia, bladder retroflexion, and a mass lesion in the hernial sac. Mild renal pelvis distension (5.9 mm) can be observed.

Fig. 2

Ultrasound findings for the right kidney at 2 days after repair surgery in a dog that presented with perineal hernia, bladder retroflexion, and a mass lesion in the hernial sac. Severe distention of the right kidney can be seen. The short and long axes of the renal pelvis measure 31.1 (A) and 37.3 (B) mm, respectively. The right ureter also showed severe distention (13.7 mm).

Fig. 3

Gross appearance of the urinary bladder during exploratory laparotomy after perineal hernia repair in a dog. The bladder neck is strangulated by fibrous tissue connected to the necrotic adipose tissue, causing discoloration and congestion of the urinary bladder (asterisk). The fibrotic band is isolated by the tip of the forceps. A mildly dilated left ureter can be identified (white arrow).

Fig. 4

Gross appearance of the urinary bladder after resolution of the strangulation that developed after perineal hernia repair in a dog. The strangulation was resolved by fibrous tissue removal. The color of the bladder has recovered to normal immediately after the procedure. Dilation of the right (black arrow) and left (white arrow) ureters has persisted.