Arq. Bras. Med. Vet. Zootec., v.77, n.2, e13325, 2025 http://dx.doi.org/10.

1590/1678-4162-13325
Case Report - Veterinary Medicine

Unilateral perineal hernia in female cat - case report Page 1 a 8

[Hérnia perineal unilateral em gata – relato de caso]

D.P. Alves1 , T.L. Risso1 , T.M. Moreira ¹ , K.L.S. Navarro¹ , F.F.P.C. Barros2 ,
M.E.S.L. Fernandes2 , H.J.M. Souza2
1
Graduate, Hospital Veterinário, Universidade Federal Rural do Rio de Janeiro, Seropédica, RJ, Brasil
2
Universidade Federal Rural do Rio de Janeiro, Seropédica, RJ, Brasil

ABSTRACT

The objective is to report a clinical surgical case of perineal unilateral hernia in a female feline, neutered,
13-years old, mixed-breed admitted in the “hidden for review” Veterinary Hospital presenting prostration,
constipation, volume increase and pain in right perineal region started two weeks ago. On clinical
inspection it was possible to visualize a rigid, irreducible and painful increased volume in the right
perineal region. Ultrasound showed that the increased volume was a hernia containing the colon. The
surgical correction was made with herniorrhaphy. One week after the surgical procedure the patient
presented a cutaneous abscess, probably originated from fecal contamination, and it was treated by
prolonging the use of systemic antibiotics and cleaning of the site. On 45-days after the surgical
procedure the patient did not show signs of pain or discomfort and defecated normally. It is suggested that
despite perineal hernias being unusual in females, especially neutered, this disease should be included as a
differential diagnosis in animals presenting increase of perineal volume, regardless of sex. The classical
technique with sutures was considered fast, with low trauma, unlike other correction techniques, besides
being successful, avoiding recurrence of the condition and bringing comfort and well-being to the patient.

Keywords: classic herniorrhaphy, cutaneous fistula, feline

RESUMO

Objetiva-se relatar um caso clínico cirúrgico de hérnia perineal unilateral em felino, fêmea castrada, 13
anos, sem raça definida, atendida no Hospital Veterinário “escondido para revisão”, a qual apresentava
prostração, constipação, aumento de volume e dor em região perineal direita. A correção cirúrgica se
deu por herniorrafia. No pós-operatório foram utilizados antibiótico, anti-inflamatório, analgésico e
laxante osmótico. Os curativos foram feitos com limpeza, utilizando-se solução fisiológica e pomada
antimicrobiana. Após uma semana do procedimento cirúrgico, a paciente apresentou aumento de volume
flutuante na região da cirurgia, que evoluiu para uma fístula cutânea, drenando moderada quantidade de
líquido purulento, que foi resolvido estendendo o uso de antibiótico sistêmico e limpeza local. Em 45 dias
pós-operatório, a paciente não demonstrava mais sinal de dor ou desconforto, e defecava normalmente.
Sugere-se que, apesar de as hérnias perineais serem pouco comuns em fêmeas, sobretudo castradas,
deva-se incluir essa afecção como diagnóstico diferencial em animais com aumento de volume perineal,
independentemente do sexo. A técnica clássica com utilização de suturas foi considerada simples, rápida,
fácil e pouco traumática, diferentemente das demais técnicas de correção, além de ter sido bem-sucedida,
evitando recidiva do quadro e conferindo conforto e bem-estar à paciente.

Palavras-chave: felino, fístula cutânea, herniorrafia clássica

INTRODUCTION perineum due to a failure in the development of

 this tissues or by a tissue fragility that facilitates
Hernias are described as the passage of the the muscle and fascia to rip allowing the passage
viscera through their natural cavity. They of viscera for inadequate anatomical regions,
generally occur in the diaphragm and the changing the syntopy between the organs
involved (Moreira, 2020). Hernias are classified
according to where they occur such as:
Corresponding author: dpdanielpinho@gmail.com
Submitted: June 7, 2024. Accepted: September 16, 2024.
 Alves et al.

diaphragmatic, umbilical, inguinal, femoral, and ischemia. These factors contribute to putting the
perineal. Regarding the structures involved they case on the worse prognosis (Fossum, 2021).
are classified as true or false (Fossum, 2021).
And they are classified as reducible or This paper aimed to report the clinical surgical
irreducible regarding their introjection (Aquino conduction of a unilateral perineal hernia
Neto, 2023). in a female feline patient, neutered, 13-years
old, mixed-breed, presenting prostration,
Perineal hernia is the result of weakening and constipation, volume increase and pain in the
withdrawal of the pelvic diaphragm musculature, right perineal region admitted in the “hidden for
allowing caudally transit of abdominal and review” Veterinary Hospital.
intrapelvic organs to the perineum subcutaneous
cellular tissue (Swieton et al., 2020). The most CASUISTRY
common muscles involved are the sphincter ani A female feline patient, neutered, 13-years old,
externus, levator ani and obturator internus mixed-breed, weighing 3.5 kg, non-tested for
(Fossum, 2021). Affects more frequently dogs, FIV and FeLV was attended to “hidden for
occurring in cats only 0,1 a 0,4% of the reported review” Veterinary Hospital presenting
cases. It is more common in non-neutered male prostration, constipation, volume increase and
dogs over 7-years old (Swieton et al., 2020). It is pain in right perineal region (Fig.1) with two
a multifactorial disease, predisposed by weeks evolution. According to her tutor, the
hormonal influences, body conformation, animal did not experience any traumatic event
neurogenic atrophy, and factors that provoke but has street access and engaged in fights with
tenesmus and dysuria such as prostatomegaly, another cat.
constipation, cystitis, and urolithiasis
(Shaughnessy e Monnet, 2015; Swieton et al., In the physical exam patient presented heart rate
2020). of 160 beats per minute and respiratory rate of 60
breaths per minute with no changes in
The diagnosis is based on medical history, clinic auscultation, rectal temperature 39ºC, capillary
evaluation demonstrating increase of the perineal refill time 2 seconds, normal colored mucosa,
volume reducible or not, and in imaging exams and no alteration in lymph nodes and abdominal
like abdominal ultrasound that facilitates the palpation. In the evaluation it was possible to
identification of the structures involved and rule observe an increase of rigid, painful, and
out presence of neoformations that resemble irreducible volume in the right perineal region
irreducible hernias, and abdominal and pelvic (Fig. 1). To close the definitive diagnostic,
radiography that allows the identification of ultrasound was performed which confirmed
fractures in the hip and visualization of the pelvic unilateral perineal hernia in the right region with
canal and herniated organs. To the general the presence of colon containing feces inside
patient evaluation, laboratory tests are important (Fig. 2).
such as blood count and renal and hepatic serum
biochemistry (Moreira et al., 2020). Since the patient presented pre-operatory
constipation, abdominal radiography was
Perineal hernia treatment is surgical and aims to performed to evaluate the colon, and it was
correct muscle defects using sutures or muscle possible to discard the megacolon suspicion.
flap and synthetic fabrics when the musculature Hematological blood count and serum
is fragile or the opening too extensive. It is biochemistry exams were made. Biochemistry
imperative that the patient is stable and treated didn't show any alteration. Hematology showed
before the surgical procedure. When constipated, lymphopenia (781/µL ref: 1500-7000/µL) with
the patient may benefit from the use of reactive lymphocytes. Patient was sent to
emollients (Moreira et al., 2020). surgical service and therapy with Ondansetron
The severity and the clinical signs can change (0.5mg/kg; BID), Cobavital (0.5mg/kg; SID) and
mostly because of the content present in the osmotic laxative (0.5g/kg; SID) was initiated
hernia, and if there is or isn't viscera entrapment. until the day of surgery. Dipyrone (25 mg/kg;
Bladder retroflexion can lead to dysuria, anuria SID) and Tramadol hydrochloride (1mg/kg;
and stranguria. However, chronic entrapment of BID) for 7-days.
intestinal loops can lead to necrosis and bowel

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 Unilateral perineal…

A B

Figure 1. Photographic image of physical palpation exam in a female feline patient, neutered, 13-years
old, 3,5 kg, admitted in the “hidden for review” Veterinary Hospital, presenting rigid, irreducible and
painful increased volume in right perineal region, besides pain on palpation, with two weeks evolution. A
Surgery service “hidden for review”, 2024.

Figure 2. Abdominal ultrasound of right perineal region in a female feline, neutered, 13-years old, 3.5kg,
admitted in the “hidden for review” Veterinary Hospital, confirming perineal hernia and showing colon
presence (blue arrow), solid fecal content (yellow arrow) and acoustic shadow originating from the
content (orange arrow). Font: Imaging service “hidden for review”.

Arq. Bras. Med. Vet. Zootec., v.77, n.2, 2025 3

 Alves et al.

A
B

Figure 3. Postoperative abdominal radiography in ventrodorsal (A) and latero lateral (B) position in a
female feline patient, mixed-breed, 3.5kg, 13-years old, admitted in the “hidden for review” Veterinary
Hospital. Notice absence of abdominal content in the perineal region. And full colon but without
megacolon characteristic dilatation. Font: Imaging service “hidden for review”.

Surgical correction was made using classic polydioxanone 3-0 absorbable thread in simple
herniorrhaphy between sphincter ani externus, continuous suture pattern (Fig. 4E) and the skin
levator ani and obturator internus muscles. The synthesis with nylon non absorbable thread 3-0
patient was positioned in sternal decubitus, with in Sultan pattern (Fig. 4F).
a towel under perineal region to maintain it
elevated, and a tobacco-pouch suture was The prescribed post-surgery medications were
performed to close the anus (Fig. 4A) and avoid Meloxicam (0.05 mg/kg; SID; for three days),
surgical site contamination. Skin incision was Dipyrone (12.5mg/kg; SID; for six days),
made with nº24 scalpel blade in elliptical shape Laxative (1g/kg; SID; until further
and right after was possible to visualize hernial recommendation), Giardicid (1mL/2kg; BID; for
sac, which was incised with iris scissors, seven days), cleaning of the surgical wound with
showing herniated colon with normal saline solution, and antimicrobial ointment twice
macroscopic appearance (Fig. 4B). With help of a day until the stitches were removed.
the surgical assistant index finger the structures
were reduced through the muscle defect. One week after surgery, the patient presented
Herniorrhaphy was performed with nylon non increased volume, warm and sore in perineal
absorbable thread 2-0 in Sultan pattern, starting region close to the surgical wound,
in the dorsoventral direction (Fig. 4C) and characterizing abscess, and 3-days after, this
maintaining the sutures repaired, without tying abscess rupture expelling a moderate amount of
the knots until the thread passes the most ventral purulent liquid through a cutaneous fistula
point of the defect. The stitches were tied with a (Fig 5A). This was resolved by extending the
double knot followed by four simple knots in administration time of antibiotics and cleaning of
dorsoventral direction. After sutures the the wound for another 20-days after skin stitches
procedure was checked to confirm the correct removal. On 45-days post-surgery, the patient
closure of the defect (Fig. 4D), being necessary didn't show any sign of pain or discomfort and
one more simple interrupted suture between defecated normally without medications
sphincter ani externus and levator ani muscles. (Fig. 5B).
Subcutaneous tissue was reduced with

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 Unilateral perineal…

A B

C D

E F

Figure 4. Perineal herniorrhaphy surgery in female feline, mixed-breed, weighing 3,5kg, 13-years old,
admitted in the “hidden for review” Veterinary Hospital. A - Patient positioned in sternal decubitus with
anal occlusion made with tobacco-pouch suture (yellow arrow). B - Herniated colon with normal
macroscopic appearance exposure after opening the hernial sac (yellow arrow). C - Sultan pattern
herniorrhaphy in dorsoventral direction reduced with finger help (yellow arrow). D - Last stitch in Sultan
pattern herniorrhaphy (yellow arrow). E - Surgical aspect after the subcutaneous synthesis (yellow arrow).
F - Surgical aspect after demography (yellow arrow). Font: Surgery service “hidden for review”, 2024.

Arq. Bras. Med. Vet. Zootec., v.77, n.2, 2025 5

 Alves et al.

A B

Figure 5. A - Cutaneous fistula 10-days post perineal herniorrhaphy surgery in female feline patient,
neutered, 13-years old, 3.5kg, admitted in the “hidden for review” Veterinary Hospital (yellow arrow).
B - Surgical wound fully healed and perineal region without volume increase within 45-days post-surgery
(yellow arrow). Font: Surgery service “hidden for review”, 2024.

DISCUSSION al., 2005). It is worth highlighting that the patient

in this report did not present urinary alterations
Perineal hernia is more often described in male or megacolon. However, it is believed that the
dogs and when it affects felines it is expected fact the patient is semi-domiciled and the
that these are neutered males, differently than possibility that she suffered some kind of trauma
observed in the patient of the reported case. A predisposed the perineal hernia occurrence.
study registered that 67% of cats affected by this
disease were neutered and with ages between 1 The most observed clinical signs in patients with
and 18-years old, 10-years average, which perineal hernia are tenesmus, constipation and
corroborates the age of the patient in the present increase of perineal volume, which were present
study (Hubers et al., 2022). Although the feline in the reported patient (Bernicker et al., 2021).
in this study had unilateral perineal hernia (right The diagnosis is initiated with physical exam,
side), according to the literature the bilateral palpation of muscle defect and the volume
occurrence is not unusual in felines (Moreira et increase, being possible sometimes reintroduce it
al., 2020). manually, which was not possible in the reported
patient. Radiography and ultrasound were of
Perineal hernia in cats can be correlated to great value in cases like that, as observed in this
urethrotomy for urinary system alterations, since paper, making possible the evaluation of the
these patients can present weakening of the hernia content, and confirming the suspected
pelvic diaphragm, developed after multiple diagnosis, discarding possible differential
obstructions and effort caused by dysuria diagnosis as neoformations (Mann e Souza,
(Fossum, 2021). Other possible causes are 2023).
megacolon, perineal mass, and colitis (Vnuk et

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 Unilateral perineal…

Osmotic and emollient laxatives in the post- experience, hernia content, disease evolution
surgical are recommended in the intention to time and the chosen technique to the correction.
facilitate the gastrointestinal transit, avoiding The most used technique is the classic, also
pushing when defecating, which can predispose known as anatomical repositioning, and the
the hernia recurrence (Fossum, 2021). Many transposition of the obturator internus muscle
complications are observed in the post-surgical technique. Transposition of the obturator internus
of perineal hernia such as suture dehiscence, muscle technique, despite greater difficulty
fecal or urinary incontinence, local infection, execution, results in less anal deformation and
lesion on pudendal or sciatic nerve, suture creates a ventral muscular ''flap'', presenting less
penetration into rectal lumen or anal sacs and the tensions on the sutures. The advantages of
hernia recurrence, are usually described in the classical technique are the easier execution and
literature. Fecal incontinence, permanent or less surgical trauma. Recurrence rates in the
temporary, happens approximately in 10% of the transposition of the obturator internus technique
cases, may occur due to direct lesion in sphincter are considered low, about 5%, in comparison
ani externus muscle during the surgical with the classical technique that presented about
dissection, or lesion in pudendal or rectal caudal 46% of recurrence. However, besides the rates
nerve (Mann and Souza, 2023). Lesion in the shown in the literature being considerably
sciatic nerve happens in less than 5%, and it is higher, the anatomical repositioning technique
correlated to the suture passage around has easier execution and causes less trauma in
sacrotuberous ligament, and the positioning of the muscle tissues, being the most usually chosen
the animal in the surgical table, that can cause (Moreira et al., 2020). The technique of classical
positional sciatic neuropraxia due to excessive herniorrhaphy with sutures was the one chosen in
ischemia or tension (Atthiesen, 1989). this case, being considered simple, fast, and little
traumatic, different from the other possible
In the present report the observed complication correction techniques, besides being well
was a subcutaneous abscess, being dehiscence or succeeded, avoiding the recurrence of the
abscess formation and wound infection prevalent condition and providing comfort and well-being
problems occurring between 6.4 and 26% of the to the patient.
cases, and usually being related to fecal
contamination for its proximity to the anus CONCLUSION
(Moreira et al., 2020). Escherichia coli is the
main agent found in perineal wound infections, Perineal hernia despite being less common in the
and a broad-spectrum antibiotic should be feline species, especially related to neutered
administered, such as the one recommended to female animals, should be considered a
the patient in the present study. The abscess differential diagnosis in any patients with
formation and later cutaneous fistula probably tenesmus, pain and perineal volume increase
originated because it is a contaminated area, near regardless of the sex. It is suggested that besides
to the anal region and in contact with feces. That perineal hernias being unusual in females,
said, it highlighted the importance of antibiotics especially neutered, this condition should be
prescription and care with the wound in the post- included as a differential diagnosis in animals
surgical. with perineal volume increase, regardless of the
sex. Detailed physical evaluation and imaging
The golden pattern therapy is the surgical exams are essential to the correct diagnosis
correction of the muscle defect by classical conclusion. The affected patients should be
herniorrhaphy with sutures or muscle flap, as the submitted to perineal herniorrhaphy, and in the
elevation of obturator internus and the present report the classical herniorrhaphy
translocation of the semitendinosus muscle, technique with sutures was considered simple,
besides synthetic materials as polypropylene fast, low trauma and with good success rates,
surgical mesh (Bernicker et al., 2021). The avoiding the recurrence of the condition and
recurrence rates vary depending on the surgeon’s providing comfort and well-being to the patient.

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 Alves et al.

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