Low-cost options for treating rectal diverticulum/perineal hernia

Re: Low-cost options for treating rectal diverticulum/perineal hernia

Michael Woodhouse — Thu, 04 Jul 2013 14:28:18 GMT

Weird suggestion but would haemorrhoid cream do any good?

Never tried it myself (or on a patient )

Re: Low-cost options for treating rectal diverticulum/perineal hernia

Evelyn Barbour-Hill — Thu, 04 Jul 2013 01:22:43 GMT

I don't think I've ever seen a rectal diverticulum. If i did I didn't recognise it.

Re: Low-cost options for treating rectal diverticulum/perineal hernia

John Flynn — Wed, 03 Jul 2013 22:49:20 GMT

[quote user="Evelyn Barbour-Hill"]But, I don't see how colopexy would do the slightest good for a rectal diverticulum.[/quote]

Maybe it depends where it is? I'm not honestly sure when colon becomes rectum?

Can't say I remember seeing or treating a rectal diverticulum like this, so I accept your point that this maybe isn't a good idea then.

Re: Low-cost options for treating rectal diverticulum/perineal hernia

John Flynn — Wed, 03 Jul 2013 22:36:18 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="John Flynn"]Indeed, colopexy and vasopexy stands a pretty good chance of success - similar to direct perineal hernia repair I believe -[/quote]

I suggested this to an eminent American lecturer (possibly tactlessly, as he had just delivered a lecture on how to repair the hernia with various mystic muscle transpositions) because it seemed to me from an engineering point of view both logical and wise. I received a politely phrased but rather acid putdown.

I also suggested to Dr. "Jerry" Davies that vasopexy was a cool idea in addition to direct repair and received a brutal putdown in true Davies style. (Admittedly I had earlier been rather critical of him over his penchant for putting rather large sutures through the lumen of a hollow organ, so I was really asking for it.)

[/quote]

I remember suggesting why use fancy foreign grafting materials when you had perfectly good vaginal tunic available after the inevitable castration...

http://www.scielo.br.ezproxy.liv.ac.uk/pdf/cr/v40n2/a464cr1999.pdf for pictures and case series on colopexy/vasopexy approach (I'd leave the cystopexy out personally). I'm pretty sure there's other publications out there, I remember reading one about a decade ago from European Companion Animal Journal or similar.

I'll confess to doing them staged myself (laparotomy + castration first, IOM flap couple of weeks later) as I just think it's easier and don't do many (maybe one or two a year), but I suspect an experienced surgeon doing many gets as good results from a single direct approach procedure. It's always a toss-up whether to do the second part of the staged procedure, however, as the clients are usually happy with the result from the first part alone...

Re: Low-cost options for treating rectal diverticulum/perineal hernia

Evelyn Barbour-Hill — Wed, 03 Jul 2013 22:27:46 GMT

[quote user="John Flynn"] stands a good chance of sorting straining from perineal hernia or rectal diverticulum [/quote]

But, I don't see how colopexy would do the slightest good for a rectal diverticulum.

Why haven't we got a "smug smirk" emoticon?

Re: Low-cost options for treating rectal diverticulum/perineal hernia

Evelyn Barbour-Hill — Wed, 03 Jul 2013 22:18:30 GMT

[quote user="John Flynn"]Indeed, colopexy and vasopexy stands a pretty good chance of success - similar to direct perineal hernia repair I believe -[/quote]

Re: Low-cost options for treating rectal diverticulum/perineal hernia

John Flynn — Wed, 03 Jul 2013 20:50:21 GMT

You might find that removing the polyp (even just tying a piece of nylon/catgut round its base as best possible +/- excising) would be a reasonbaly cheap and cheerful approach with a quickish GA and might lead to resolution of the straining.

Many dogs manage fine with PH's if other issues such as the rectal polyp / prosatic hyperplasia etc are dealt with. Avoiding diarrhoea also helpful.

Alternatively (increasing cost I'm guessing...) a quick colopexy is surgery that any one doing abdominal surgery for spays etc is likely to find within their capabilities and stands a good chance of sorting straining from perineal hernia or rectal diverticulum Just pull the rectum back (like stretching a sock a bit) and stitch to the correct side with some nylon.

Indeed, colopexy and vasopexy stands a pretty good chance of success - similar to direct perineal hernia repair I believe - and is probably more within your comfort zone if you're happy with abdominal surgery but don't like the idea of approaching the perineum with a scalpel.

Re: Low-cost options for treating rectal diverticulum/perineal hernia

Robin Grimmer — Wed, 03 Jul 2013 19:50:41 GMT

Vitamin P injection. Cheap and 100 per cent effective.

Re: Low-cost options for treating rectal diverticulum/perineal hernia

Anthony Dennison — Wed, 03 Jul 2013 17:57:45 GMT

I did mention euthanasia to the owner, but for a 12 year old GSD he's in remarkably good nick!

Re: Low-cost options for treating rectal diverticulum/perineal hernia

Sarah Keir — Wed, 03 Jul 2013 17:53:16 GMT

Or euthanasia? Often the cheapest option...

Re: Low-cost options for treating rectal diverticulum/perineal hernia

mariette asselbergs — Wed, 03 Jul 2013 16:06:55 GMT

I agree, horrible condition, can only get worse without surgery. Only solution maybe phone around for the cheapest vet?

Mariette

Re: Low-cost options for treating rectal diverticulum/perineal hernia

Evelyn Barbour-Hill — Wed, 03 Jul 2013 14:58:29 GMT

You won't mind me pointing out that rectal diverticulum (quite rare I believe) is completely different from perineal hernia (rather common). . There. That's got that out of the way.

I'm afraid I don't know any useful treatment other than surgical repair.

Not only is the thing not going to get better, it's probably going to get worse.

Lactulose or fibre-y things might help a bit with the mild or early case for a while.

You could have the dog in once a week or fortnight to digitally excavate the rectum.. I'm not entirely joking, I have done that in the past. Everybody except the owner gets fedup with it pretty quickly, the owner takes a little longer.