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TUGAS MATA KULIAH

ILMU BEDAH KHUSUS VETERINER

“TEKNIK OPERASI PERINEAL FISTULA & FISTULA RECTOVAGINALIS”


Disusun Oleh :
Kelompok 5
KELAS C

1. Satria Aji Pratama 1609511087


2. Rani Utami Putri 1609511088
3. Ni Wayan Ayu Rukmini 1609511091
4. Aditya Try Mahindra 1609511093
5. Ni Kadek Chris Nariasih 1609511105
6. Rama Purnomo 1609511114

LABORATORIUM BEDAH VETERINER


FAKULTAS KEDOKTERAN HEWAN
UNIVERSITAS UDAYANA
TAHUN 2019

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RINGKASAN
Perianal Fistula adalah merupakan saluran yang dalam, sangat berkembang dan
mengandung nanah pada jaringan perianal. Perianal sering terjadi pada anjing-anjing ras
besar. Perianal fistula sering juga disebut perianal sinus, perianal fissure, furunculosis,
pararectal fistula anusitis, fistuna-in-ono dan anorectal abses. Pada anjing yang terkena,
kondisi ini biasanya berhubungan dengan infeksi di daerah perianal, dan biasanya ada satu
atau lebih menguras saluran yang ada. Fistula Rectovaginalis adalah terjadinya penyatuan
abnormal yang terjadi antara dinding dorsal vagina dan bagian ventral rektum, sehingga
fungsi vulva sebagai saluran umum untuk saluran urogenital dan gastrointestinal. Operasi
fistula rectovaginalis adalah operasi yang dilakukan pada tengah-tengah bagian rectum
dan vagina yang mengalami penyumbatan karena obstruksi labia baik secara alami atau
trauma.
Kata Kunci : Perianal Fistula, Fistula Rectovaginalis

SUMMARY
Perianal Fistula is a deep, highly developed, pus-filled channel of the perianal tissue.
Perianal often occurs in large breeds of dogs. Perianal fistula is often also called perianal
sinus, perianal fissure, furunculosis, pararectal fistula anusitis, fistuna-in-ono and
anorectal abscess. In affected dogs, this condition is usually associated with infection in
the perianal area, and there is usually one or more drains in the drain. Rectovaginal
fistula is an abnormal union that occurs between the dorsal wall of the vagina and the
ventral rectum, so that the vulva functions as a common channel for the urogenital and
gastrointestinal tract. Rectovaginal fistula surgery is surgery performed in the middle of
the rectum and vagina that is blocked due to obstruction of the labia either naturally or
traumatized.
Keywords: Perianal Fistula, Fistula Rectovaginalis

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KATA PENGANTAR

Puji syukur penulis panjatkan kepada Tuhan Yang Maha Esa karena berkat
rahmat-Nya lah penulis dapat menyelesaikan paper pada mata kuliah Ilmu Bedah
Khusus Veteriner semester VII yang berjudul “Teknik Operasi Perineal Fistula &
Fistula Rectovaginalis” dengan tepat waktu.
Tidak lupa penulis ucapkan terima kasih kepada pihak-pihak yang telah
turut membantu dalam penyelesaian paper ini. Penulis sadari pula bahwa paper ini
masih sangat jauh dari kesempurnaan, maka dari itu penulis mengharapkan kritik
dan saran yang membangun serta bantuan dari semua pihak demi tersusunnya paper
yang jauh lebih baik, akhir kata penulis ucapkan terima kasih.

Denpasar, 28 Oktober 2019


Hormat Kami,

Penulis

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DAFTAR ISI

HALAMAN JUDUL .............................................................................................. i


RINGKASAN / SUMMARY................................................................................ ii
KATA PENGANTAR......................................................................................... iii
DAFTAR ISI ....................................................................................................... iv
DAFTAR GAMBAR............................................................................................. v
DAFTAR LAMPIRAN ....................................................................................... vi
BAB I PENDAHULUAN
1.1 Latar belakang ............................................................................................ 1
1.2 Rumusan Masalah ...................................................................................... 2
1.3 Tujuan Penulisan ........................................................................................ 2
BAB II TINJAUAN PUSTAKA
2.1 Pengertian Perineal Fistula & Fistula Rectovaginalis................................. 3
BAB III PEMBAHASAN
3.1 Persiapan Operasi........................................................................................ 4
3.2 Teknik Operasi ........................................................................................... 5
3.3 Pasca Operasi ............................................................................................... 8
BAB IV PENUTUP
4.1 Simpulan ...................................................................................................... 9
4.2 Saran............................................................................................................. 9
DAFTAR PUSTAKA ........................................................................................ 10

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DAFTAR GAMBAR
Gambar 1. Perianal fistula pada anjing.................................................................. 6
Gambar 2. Bedah dengan sayatan.......................................................................... 6
Gambar 3. Setelah sembuh dari pembedahan........................................................ 7
Gambar 4. Rectovaginal pada anjing betina setelah 1 bulan................................. 7

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DAFTAR LAMPIRAN

Lampiran 1. Rectovaginal fistula in dog with a normal anus : a case report.


Lampiran 2. Congenital rectovaginal fistula with atresia ani in a Heifer: a case
report.
Lampiran 3. Atresia Ani: a congenital defect & its successful management in
non-descript calf.

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BAB I

PENDAHULUAN

1.1 Latar Belakang

Fistula atau fistel merupakan bahasa latin yang artinya pipa. Fistel merupakan
hubungan atau jalur antara dua epitel organ atau jaringan yang normalnya tidak
berhubungan.

Fistula vesicovagina merupakan hubungan abnormal antara vagina dan vesica


urinaria. Sedangkan fistel rectovaginalis merupakan hubungan abnormal antara
rectum dan vagina. Kedua kondisi diatas dapat timbul sebagai komplikasi dari
persalinan maupun penyakit pada daerah tersebut. Berdasarkan etiologinya, dapat
dibagi menjadi:

1. Fistel obstetri, fistel yang timbul akibat : Partus lama atau partus dengan
tindakan, seperti pada tindakan SC, kranioklasi, dekapitasi,
ekstraksidengan cunam,seksio-histerektomia
2. Fistel gynekologi, fistel yang timbul akibat tindakan operasi pada pasien
dengan carcinoma, terutama carcinoma cervix. Pasien dengan operasi
histerektomi.
3. Fistel traumatik, fistel yang timbul akibat komplikasi pemasangan
kateter, kecelakaan dan pasien dengan abortus kriminalis
Fistula anorektal yang sering pula disebut fistel ani atau
fistel perianal/paraanal.fistula anorektal adalah komunikasi abnormal antara anus
dan kulit perianal. Kelenjar pada kanalis analis terletak pada linea dentate,
menyediakan jalur organisme yang menginfeksi untuk sampai pada daerah
intramuscular

Fistula dapat muncul secara spontan atau sekunder karena abses perianal
(atauperirektal). Faktanya, setelah drainase dari abses periani, hampir 50 %
terdapat kemungkinan untuk berkembang menjadi fistula yang kronik. Fistula
lainnya dapat terjadi sekunder karena trauma, penyakit Crohn. fisura ani,
karsinoma, terapi radiasi, aktinomikosis, tuberculosis, dan infeksi klamidia

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1.2 Rumusan Masalah

1. Apakah yang dimaksud dengan Teknik Operasi Perineal Fistula & Fistula
Rectovaginalis?
2. Bagaimana persiapan operasi Perineal Fistula & Fistula Rectovaginalis?
3. Bagaimana teknik operasi Perineal Fistula & Fistula Rectovaginalis?
4. Bagaimana pasca operasi Perineal Fistula & Fistula Rectovaginalis ?
1.3 Tujuan

Tujuan dari penulisan makalah ini ialah mengetahui apa yang dimaksud
dengan Teknik Operasi Perineal Fistula & Fistula Rectovaginalis, bagaimana
teknik Perineal Fistula & Fistula Rectovaginalis, dan bagaimana terapi post
operasinya. Hal-hal ini akan diperlukan sebagai referensi pengetahuan jika sudah
menjadi dokter hewan.

1.4 Manfaat

Setelah melakukan penulisan diharapkan mahasiswa dapat mengerti dan


mengetahui manfaat dan kegunaan operasi Perineal Fistula & Fistula
Rectovaginalis. Selain itu mahasiswa juga diharapkan mengetahui tata cara
pelaksanaan tata cara pelaksanaan operasi Perineal Fistula & Fistula
Rectovaginalis

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BAB II

TINJAUAN PUSTAKA

Perianal fistula adalah saluran yang dalam, sangat berkembang dan


mengandung nanah pada jaringan perianal. Perianal fistula paling sering terdapat
pada anjing-anjing ras besar. Perianal fistula sering juga disebut perianal sinus,
perianal fissura, furunculosis, pararectal fistula, anusitis, fistuna-in-ono, atau
anorectal abses (Sudisma, 2016).

Recto – vaginal fistula atau anus vaginalis adalah kelainan kongenital yang
mematikan dimana ada saluran abnormal di antara rektum dan vagina, dan kotoran
terhambat keluar (anus imperforate). Atresia ani jenis fistula recto- vaginal
dilaporkan pada banyak spesies hewan betina, seperti pada hewan domba, anjing,
kucing, babi dan kuda. Kondisi ini perlu ditangani sejak dini untuk menghindari
infeksi sistem urogenital seperti sistitis, vaginitis, cervicitis, endometritis,
kegagalan pembuahan dan kawin berulang (Chen et al., 2015). Fistula rektovaginal
dapat terjadi akibat trauma obsetrik, perbaikan yang kurang tepat dari perbaikan
robekan perineum derajat III, trauma saat berkembang biak, abses pada perineum
atau vaginitis dan kelainan kongenital (Farhoodi et al., 2000).

Fistula rektovaginal kongenital ditandai lubang diantara dinding dorsal


vagina dan bagian ventral rektum, sehingga vulva berfungsi sebagai lubang saluran
urogenital dan gastrointestinal. Biasanya, kelainan ini berhubungan dengan atresia
tipe II, di mana rektum berakhir sebagai kantung buntu langsung ke kranial anus
yang tidak berforum. Kadang-kadang, rektum menjadi pecah karena tegangan pada
hewan yang membentuk fistula recto-vaginal, yang memungkinkan kotoran keluar
melewati pembukaan vulvular (Kumar et al., 2009). Tanda klinis meliputi bagian
tinja melalui vulva, iritasi vulva, tenesmus, sistitis, dan megacolon (Bademkiran et
al., 2009).

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BAB III

PEMBAHASAN

3.1 Preoperasi

Sebelum dilakukan pembedahan harus dilakukan persiapan operasi yang


matang agar operasi pada hewan tersebut berjalan dengan sukses dan lancar.
Persiapan yang perlu dilakukan meliputi persiapan alat, bahan dan obat, persiapan
ruang operasi, persiapan pasien, dan persiapan operator.

Persiapan alat, bahan dan obat

Alat-alat yang digunakan adalah scalpel, pisau bedah, gunting,arteri clamp,


needle holder, pinset, spuit, jarum operasi, benang vicryl, dan non absorbable silk.
Sebelum menggunakan alat tersebut harus disterilisasi dengan autoclave ataupun
alkohol 70%. Sedangkan bahan- bahan yang digunakan adalah tampon, alkohol
70%, kain drape, sarung tangan, penutup kepala, masker operasi dan lampu
penerangan. Obat- obat yang dipersiapkan adalah premedikasi yaitu atropine sulfat,
anestesi umum adalah ketamin + xilazin dan antibiotika penicillin-streptomycin

Persiapan ruang operasi

Ruang operasi harus dibersihkan, meja operasi harus disterilkan dengan


desinfektan, didalam operasi harus tersedia lampu penerangan. Alat-alat operasi
yang telah disterilisasi disiapkan dan ditata rapi sehinggamemudahkan untuk
diambil ketika operasi.

Persiapan Operator dan pasien

Operator harus memiliki beberapa kesiapan seperti menggunakan


seperangkat alat pelindung diri (APD) yang bertujuan untuk sterilitas prosedur
pelaksanaan operasi. Selain itu operator juga memiliki kesiapan diri dan
ketrampilan dalam melaksanakan tindakan operasi. Persiapan pasien yaitu sebelum
tindakan operasi dilaksanakan, hewan terlebih dahulu dianamnesa, pemeriksaan

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fisik secara umum. Kemudian sebelum dilakukan tindakan operasi hewan harus
dipuasakan.

Pramedikasi dan Anestesi

Premedikasi merupakan pemberian obat sebelum pemberian anestesi yang


dapat diinduksi jalannya anestesi. Premedikasi dilakukan 10-15 menit sebelum
melakukan anestesi. Premedikasi bertujuan untuk mengurangi kecemasan,
memperlancar induksi, mengurangi keadaan gawat anestesi, mengurangi
hipersalivasi, bradycardia dan muntah selama anestesi. Premedikasi yang
digunakan adalah atropine sulfat diberikan secara intravena. Kemudian anestesi
digunakan ketamin dan xilazin yg diberikan secara intramuskular.

3.2 Teknik Operasi Perianal Fistula dan Fistula Rectovaginalis

 Teknik Operasi Perianal Fistula


Pembedahan dengan melakukan insisi pada glandula dapat dilakukan untuk
mengatasi perianal fistula.
1. Teknik operasi dilakukan dengan cara kelenjar anal diirigasi dahulu dengan
cairan antiseptik lemah dan dimasukan beberapa potong gauze sponge ke
dalam rektum untuk mencegah adanya kontaminasi dari feses.
2. Setelah itu glandula anal diekstirpasi dengan menggunakan sebuah grooved
director ke dalam kelenjar anal melalui orofociumnya kemudian dibuat
sayatan hingga tampak batas-batas glandula dan kantong glandula
dipisahkan dengan cara preparsi tumpul.
3. Setelah itu lakukan penutupan sayatan menggunakan chromic catgut ukuran
2-0 dan benang nonabsorbable untuk bagian luar dengan pola jahitan simple
interrupted.
4. Selanjutnya dibuat irisan melingkar disekeliling fistula-fistula yang ada.
Bagian tersebut dipisahkan sampai pada bagian spinchter ani dan
diusahakan agar spinchter ani dipertahankan.

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5. Di sekeliling anus lapisan sub-mukosa dari rektum dijahit ke bagian
subkutis dengan menggunakan chromic catgut ukuran 2-0 dan mukosa
dijahitkan ke kulit dengan menggunakan benang nonabsorbable.

Gambar 1. Perianal fistula pada anjing

Gambar 2. Bedah dengan sayatan

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Gambar 3. Setelah sembuh dari pembedahan

 Teknik Operasi Fistula Rectovaginalis


Fistula Recto-vaginal ditangani dengan dua metode :
1. Metode pertama, rektum dan bibir vulvular yang mengalami
kelainan ditutup secara individual setelah isolasi dan transeksi
fistula. Pembukaan anus direkonstruksi setelahnya.
2. Dalam metode kedua, penseksian dari rektum dilakukan hanya pada
bagian anterior fistula, bagian rektum yang rusak dipotong dan
dijahit pada bagian luar recta dan tepi kulit yang terbuka.

Gambar 4. Rectovaginal pada anjing betina setelah 1 bulan

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3.3 Pasca Operasi

Penanganan Perianal fistula dan Rectovaginal fistula harus dengan prosedur


yang baik dan harus dengan tingkat sterilisasi yang tinggi karena operasi
berhubungan dengan bagian mukosa dari system digesti. Perawatan pasca operasi
dilakukan sesuai dengan kondisi pasien yang ada, jika tidak mau makan bisa dengan
pemberian infus, untuk mencegah infeksi berikan antibiotic, untuk menghidari
adanya radang bisa diberikan anti inflamasi. Kemudian lakukan pengecekan secara
berkala terhadap bagian yang telah di operasi agar jika tejadi kelainan bisa
terdeteksi dengan baik.

Secara umum perawatan pasca operasi perianal fistula Ada 3 prinsip yaitu :

a) Terapi Immunosupresif atau Immunomodulatery


Disini ada 2 fase yaitu : Fase Induksi. Untuk mengatasi gejala klinis yang
muncul. Perlakuan Pasca Operasi Fistula rectovaginalis dan Fase
Pemeliharaan. Untuk mencegah terjadinya kekambuhan penyakit.
b) Terapi Diet : Pembatasan Protein novel dan protein yang terhidrolisasi.
c) Terapi Higeni : Jaga daerah tetap kering dan bersih dan berikan terapi
antibiotik.

 Perlakuan Pasca Operasi Fistula rectovaginalis


a) Pemberian Antibiotik, Penicillin-Streptomycin selama 5 hari, I.M
b) Pemberian NSAIDs, untuk beberapa hari
c) Pencucian (irigasi) dengan larutan Normal Saline, 2 kali sehari, dikuti
pemberian Neomycin Sulphate
d) Benang (silk) diambil 14 hari post operasi

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BAB IV PENUTUP

4.1 Simpulan

Kebanyakan fistula berawal dari kelenjar dalam di dinding anus atau


rektum. Kadang-kadang fistula merupakan akibat dari pengeluaran nanah pada
abses anorektal. Penyebabnya sering tidak diketahui. Operasi perianal fistula juga
dilakukan untuk menghilangkan gangguan di anus agar proses gastrointestinal
menjadi lancar dan tidak terganggu, mencegah hipofungsi dari anus, mencegah
adanya tumor, dan lain-lain.Fistula rektovaginal kongenital ditandai lubang
diantara dinding dorsal vagina dan bagian ventral rektum, sehingga vulva berfungsi
sebagai lubang saluran urogenital dan gastrointestinal.

4.2 Saran

Sebelum melakukan operasi perineal fistula dan fistula rectovaginalis


disarankan untuk memperhatikan hal-hal berikut yaitu : umur hewan ternak, metode
atau teknik disesuaikan dengan umur hewan, pemilihan alat yang sesuai dengan
indikasi penyakit.

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DAFTAR PUSTAKA

Bademkiran, Servet et al. 2009. Congenital Recto Vaginal Fistula with Atresia
Ani in a Heifer: A Case Report. Turkey: Dicle University.

Ellison, Gary W. 2009. Perianal Fistulas / Anal Fistulas; A Medical Disease That
Sometimes Needs Surgery. Florida: University of Florida.

Farhoodi. I. Nowrouzian. P. Hovareshti. M. Bolourchi. M.Gh. Nadalian. 2000.


Factors Associated With Rectovaginal Injuries In Holstein Dairy Cows In
A Herd In Tehran, Iran. Department of Clinical Sciences, Faculty of
Veterinary Medicine, University of Tehran

Kumar, Hemant., A.K.Sharma, L.L.Dass, Abhishek Anand. 2009. Atresia ani with
scrotal anomaly in a Goat. Veterinary World, Vol.2(2): 68

Servet Bademkiran Hasan Icen Dogan Kurt. 2009. Congenital Recto Vaginal
Fistula with Atresia Ani in a Heifer: A Case Report. Y.Y.U. Veteriner
Fakultesi Dergisi. 20 (1) 61 – 64

Sudisma, I G Ngurah. 2016. Ilmu Bedah Veteriner dan Teknik Operasi. Denpasar:
Universitas Udayana

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Veterinarni Medicina, 61, 2016 (3): 169–172 Case Report

doi: 10.17221/8769-VETMED

Rectovaginal fistula in a dog with a normal anus:


a case report
S.Y. Lee1, S.J. Park1, S.Y. Jin1, M.H. Kim1, S.H. Seok1, Y.K. Kim2, H.C. Lee1, S.C. Yeon1
1
College of Veterinary Medicine, Gyeongsang National University, Jinju, Republic of Korea
2
Haeundae Animal Medical Center, Busan, Republic of Korea

ABSTRACT: A one-year-old, 2.6 kg, spayed female Maltese dog was referred with passage of faeces coming
from the vulva, repeated vaginal discharge and vaginitis. Through physical examination, contrast radiograph and
vaginoscopic exploration, the dog was diagnosed with rectovaginal fistula which was surgically corrected. After
midline perineal incision, the rectovaginal fistula was isolated and transected. The vaginal and rectal defects were
closed separately, but dehiscence of the surgical region took place three days after surgery. For the second opera-
tion, the rectal segment containing the fistula was removed by transanal rectal pull-through, and anastomosis
was performed. Total follow-up time was 10 months and no sign of recurrence was reported. Early postoperative
complications included perineal soiling and wound dehiscence, but the long-term outcome was good. This case
is the first report of surgical correction of a rectovaginal fistula in a dog with a normal anus.

Keywords: rectovaginal fistula; rectal pull-through; dehiscence; vaginoscopy; dog

Congenital rectovaginal fistula is characterised The purpose of this report is to describe a dog with
by an embryological malformation of the urorectal rectovaginal fistula as a sole anorectal abnormality
septum which ensures the division of the cloaca into that was diagnosed and treated by surgical correc-
urethrovesical and rectal segments (Marretta and tion for the first time. 
Matthiesen 1989). Occasionally, in dogs with a fistula
between the urogenital tract and the anorectum it
is accompanied by an imperforate anus, so that the Case description
dogs show clinical signs of faecal impaction and pas-
sage of faeces through the vulva (Rawlings and Capps A one-year-old, 2.6 kg, spayed female Maltese dog
Jr. 1971; Prassinos et al. 2003; Mahler and Williams was referred with passage of faeces coming from the
2005; Rahal et al. 2007). Before weaning, the passage vulva. The dog had a six-month history of recurrent
of liquid faeces through the vulva makes the clinical vaginal discharge and vaginitis since birth. Ten days
signs of faecal impaction less obvious, so dogs with before presentation, ovariohysterectomy was per-
the abnormality are usually diagnosed after wean- formed by the referring veterinarian. Subsequently,
ing (Wykes and Olson 2003). In addition, the dam the amount of vaginal discharge increased, and the
frequently cleans the puppies, so it may be difficult brownish discharge was suspected to be faeces.
to detect the presence of faeces from the vulva (Suess A complete blood count, electrolytes and serum
et al. 1992; Prassinos et al. 2003). biochemical analyses were performed, but were
The true prevalence of rectovaginal fistula as the unremarkable. The dog received intramuscular ad-
sole congenital anorectal abnormality in a dog is ministration of 20 µg/kg medetomidine (Domitor,
unknown, but it is extremely rare. Although this Pfizer, USA) and 0.2 mg/kg butorphanol (Butophan,
abnormality has been described in a dog (Knecht Myungmoon Pharm, Korea) for sedation and an-
and Westerield 1971), clinical experience is limited algesia. Physical examination findings included
owing to the lack of cases reported in the literature. perivulvar erythaema and a small volume of fae-

169
Case Report Veterinarni Medicina, 61, 2016 (3): 169–172

doi: 10.17221/8769-VETMED

ces in the vaginal opening. Through digital rectal urogenital tract side on the dorsal vaginal wall was
examination, a fistula opening was palpated on the confirmed, cranially just above the urethral open-
ventral rectal wall 2 cm cranial to the mucocutane- ing. By the guidance of vaginoscopy, the feeding
ous junction. Owing to the short distance from the tube inserted into the fistula from the rectal open-
anus, a 6 Fr feeding tube could be inserted into the ing was pulled out through the vulva. This feeding
fistula with a finger. Then, radiographs were taken tube was used for the fistula indicator (Figure 2).
after infusion of contrast medium (Omnipaque 300, The perineum was clipped, prepared, and draped
GE Healthcare, USA) via the feeding tube, which for surgery. A vertical midline perineal incision was
seemed to be passing through the ventral rectal wall made and careful blunt dissection was performed
into the genital tract advancing toward the cervix in a cranial direction to find the fistula, which was
(Figure 1). Therefore, the feeding tube could not identified and isolated easily with the help of the
be pulled out through the vulva. A tentative diag- feeding tube inserted before surgery. The fistula was
nosis of rectovaginal fistula was established, and excised and the defects of the vaginal and rectal wall
surgical correction was recommended. Urinalysis were closed in an interrupted appositional pattern
and urine culture were performed, but no signs of with 4-0 polydioxanone sutures (PDS II, Ethicon,
urinary infection were revealed. USA) separately. Incision wounds were rinsed with
Food was withheld for 24 h and water was with- sterile saline, a Penrose drain was inserted between
held for 12 h. The dog was pre-medicated with the rectum and the vagina, and secured to the skin.
0.02 mg/kg acepromazine (Sedaject, Samu median, The musculature and subcutaneous tissue of the
Korea) and 0.2 mg/kg butorphanol intravenously. incisional site were closed separately in simple in-
General anaesthesia was induced with 3 mg/kg terrupted and continuous patterns with 3-0 poly-
propofol (Provive, Myungmoon pharm, Korea) dioxanone sutures (PDS II, Ethicon), respectively.
and maintained with isoflurane (Ifran, Hana Pharm, The skin was closed in a simple interrupted pattern
Korea) in 100% oxygen via an endotracheal tube. with 3-0 non-absorbable suture (Ethilon, Ethicon).
The dog was placed in ventral recumbency with Immediately after extubation, 0.4 mg/kg butorpha-
the tail held out of the way. To obtain an accurate nol was administered intramuscularly.
diagnosis, vaginoscopic examination was planned Before and after the surgery, 25 mg/kg cefazolin
preoperatively. Vaginoscopic exploration with a 0°, (Cefazolin, Chongkundang Pharm, Korea) every 12 h
2.7-mm diameter cystoscope (MGB, Germany) re- and 4.4 mg/kg carprofen (Rimadyl, Pfizer, USA) eve-
vealed the presence of faeces throughout the genital ry 24 h were administered intravenously. Lactulose
tract which were removed by sterile saline irriga- (Duphalac, JW Pharmaceutical, Korea) was given
tion. In addition, the exact fistula location of the orally as a stool softener. The dog started to defecate

Figure 1. Contrast radiographs were taken after infusion Figure 2. A 6 Fr feeding tube inserted into the fistula was
of iodinated contrast through the feeding tube. The com- used for fistula indicator, which facilitated exposure and
munication between the rectum and genital tract is iden- identification of the fistula during surgery
tified (black arrow)

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Veterinarni Medicina, 61, 2016 (3): 169–172 Case Report

doi: 10.17221/8769-VETMED

on the second day after surgery, but watery faeces the dog was 18 months old. Despite the history of
complicated perineal contamination continuously. repeated vaginitis since birth and occasional vagi-
Even though the surgical lesion was rinsed with flow- nal discharge, suspected to be liquid faeces, the
ing saline, wound dehiscence of the incisional site owner never noticed the presence of faeces from
occurred three days postoperatively, resulting in an the vulva. The only previously described dog with
open defect in the dorsal vaginal wall and ventral rec- this abnormality also remained undiagnosed for
tum. Exudate from the dehiscence was cultured and one year, and the presence of deformity was identi-
antimicrobial susceptibility testing was performed. fied during necropsy (Knecht and Westerield 1971).
The following day, surgical correction was per- The absence of anal obstruction resulted in less
formed employing a transanal rectal pull-through obvious clinical signs, so that the condition could
procedure. The anaesthetic protocol and surgical not be detected easily.
preparation were the same as for the former surgery. Clinical signs were sufficient to establish a di-
Traction was achieved with four stay sutures in the agnosis of these deformities, but contrast radiog-
rectal wall and the rectum was everted through the raphy provided detailed information of the fistula
anus (Hedlund and Fossum 2007). The rectal seg- between the anorectum and genital tract (Suess
ment containing the fistula was removed through a et al. 1992; Mahler and Williams 2005; Rahal et
full-thickness, 360° incision, and the normal cranial al. 2007). Insertion of a feeding tube into the fis-
rectum was anastomosed with the distal rectal stump tula and infusion of contrast material through it
in a simple interrupted appositional pattern using was useful for diagnosing the disorder in the dog.
4-0 polydioxanone suture. During the operation, Vaginoscopy showed the exact position and size of
the anal ring was preserved entirely. Debridement the fistula opening on the genital side. Moreover, it
and lavage of the wound dehiscence of the former helped the tip of the feeding tube to pass through
surgery were performed and a Penrose drain was re- the vulva, which was inserted into the fistula from
established. The vertical perineal incision was closed the anus. During separation of the fistula in the
routinely. Immediately after extubation, 0.4 mg/kg initial surgery, the feeding tube was used for the
butorphanol was administered intramuscularly. fistula indicator and was useful.
The dog received 12.75 mg/kg amoxicillin/cla- Three days after the operation, wound dehis-
vulanate (Lactamox, Schnell Biopharmaceuticals, cence occurred. This could have been caused by
Korea) orally, 10 mg/kg metronidazole (Flasiny; CJ intra- and postoperative faecal contamination of
Healthcare, Korea) every 12 h for seven days, and the surgical site (Suess et al. 1992; Aronson 2003) or
4.4 mg/kg carprofen once a day for three days. Stool tension at the sutured rectal site, but the exact rea-
softener was also administered orally. During the sons are not entirely clear. The use of stool soften-
nursing period, perineal soiling continued to be a ers resulting in watery faeces might have potentially
problem. The skin of the perineal region was rinsed played a role in increasing the contamination from
with sterile saline, and topical antimicrobial oint- faecal material that constantly dribbled onto the
ment was applied every day until suture removal. incisional site. In the secondary surgery, the rectal
Dehiscence or infection of the surgical region did segment containing the defect was resected com-
not occur, the surgical lesion healed uneventfully, pletely along with the surrounding inflammatory
and vaginal discharge and vaginitis were resolved. tissue, leaving a fresh wound with a clean border,
Follow-up information was obtained by clinical which has been recommended in human medicine
examinations, including rectal digital examination, (Li et al. 2010). Antibiotic prescription was changed
every week during the first month, and subsequent- according to the antimicrobial susceptibility test
ly the owner was interviewed by telephone every results, and faecal contamination of the surgical
month for the next 10 months. The dog remained site was minimised with the rinse and application of
well and no sign of recurrence was reported. the ointment. After that, there was no more wound
dehiscence or cellulitis in the surgical region.
In summary, a rectovaginal fistula was diagnosed
DISCUSSION AND CONCLUSIONS and surgically corrected successfully in a dog with a
normal anus for the first time. Postoperative com-
In this case, a rectovaginal fistula as a sole con- plications included perineal soiling and wound
genital anorectal abnormality was diagnosed when dehiscence, but the long-term outcome was good.

171
Case Report Veterinarni Medicina, 61, 2016 (3): 169–172

doi: 10.17221/8769-VETMED

Complete resection of the surrounding tissue in- Marretta SM, Matthiesen DT (1989): Problems associated
volving the fistula is recommended to reduce the with the surgical treatment of diseases involving the per-
possibility of wound dehiscence after the surgical ineal region. Problems in Veterinary Medicine 1, 215–
treatment. 242.
Prassinos NN, Papazoglou LG, Adamama-Moraitou KK,
Galatos AD, Gouletsou P, Rallis TS (2003): Congenital
REFERENCES anorectal abnormalities in six dogs. The Veterinary Re-
cord 153, 81–85.
Aronson L (2003): Rectum and anus. In: Slatter DH (eds.): Rahal SC, Vicente CS, Mortari AC, Mamprim MJ, Caporalli
Textbook of Small Animal Surgery. 3 rd ed. Saunders, EH (2007): Rectovaginal fistula with anal atresia in 5 dogs.
Philadelphia. 682–708. The Canadian Veterinary Journal 48, 827–830.
Hedlund CS, Fossum TW (2007): Surgery of the perineum, Rawlings CA, Capps Jr. WF (1971): Rectovaginal fistula and
rectum and anus. In: Fossum TW (eds.): Small Animal imperforate anus in a dog. Journal of the American Vet-
Surgery. 3rd ed. Mosby, St. Louis. 498–507. erinary Medical Association 159, 320–326.
Knecht CD, Westerield C (1971): Anorecto-urogenital Suess RP Jr, Martin RA, Moon ML, Dallman MJ (1992):
anomalies in a dog. Journal of the American Veterinary Rectovaginal fistula with atresia ani in three kittens. The
Medical Association 159, 91–92. Cornell Veterinarian 82, 141–153.
Li L, Zhang TC, Zhou CB, Pang WB, Chen YJ, Zhang JZ Wykes PM, Olson PN (2003): Vagina, vestibule, and vulva.
(2010): Rectovestibular fistula with normal anus: a simple In: Slatter DH (eds.): Textbook of Small Animal Surgery.
resection or an extensive perineal dissection? Journal of 3rd ed. Saunders, Philadelphia. 1502–1510.
Pediatric Surgery 45, 519–524.
Mahler S, Williams G (2005): Preservation of the fistula for Received: 2015–03–19
reconstruction of the anal canal and the anus in atresia Accepted after corrections: 2016–02–16
ani and rectovestibular fistula in 2 dogs. Veterinary Sur-
gery 34, 148–152.

Corresponding Author:
Seong Chan Yeon, Gyeongsang National University, College of Veterinary Medicine, Jinju 660-701, Republic of Korea
E-mail: scyeon@gnu.ac.kr

172
Y.Y.U. Veteriner Fakultesi Dergisi, 2009, 20 (1) 61 - 64 CASE REPORT
ISSN: 1017-8422; e-ISSN: 1308-3651

Congenital Recto Vaginal Fistula with Atresia Ani in a Heifer: A Case Report

Servet BADEMKIRAN1 Hasan İÇEN2 Doğan KURT3


1 Department of Obstetrics and Gynecology, Faculty of Veterinary Medicine, Dicle University, Diyarbakir, Turkey
2 Department of Internal Diseases, Faculty of Veterinary Medicine, Dicle University, Diyarbakir, Turkey
3 Department of Physiology, Faculty of Veterinary Medicine, Dicle University, Diyarbakir, Turkey

Received: 12.03.2009 Accepted: 30.03.2009

SUMMARY A crossbred Holstein × Yerli kara (Local breed) heifer, 9 month old age was admitted to the gynecology
clinic of Dicle University Veterinarian Faculty, with congenital recto vaginal fistula and atresi ani. This
was clinically identified as a congenital anomaly. Recto vaginal fistula and atresia ani were successfully
corrected by surgical excisions.

Key Words Crossbred Heifer, Congenital Defect, Recto-Vaginal Fistula, Atresia Ani

Bir Düvede Doğmasal Atresia Ani ile Birlikte Rekto Vajinal Fistül Olgusu

ÖZET Atresi ani ve rekto vajinal fistül şikayeti ile Dicle Üniversitesi Veteriner Fakültesi jinekoloji kliniğine 9
aylık siyah-Beyaz alaca x Yerli Kara melezi (Yerli ırk) bir düve getirildi. Bunun doğmasal bir anomali
olduğu tespit edildi. Rekto vajinal fistül ve atresia ani cerrahi olarak başarılı bir şekilde tedavi edildi.

Anahtar Kelimeler Melez Düve, Doğmasal Anomali, Rekto-Vajinal Fistül, Atresia Ani

INTRODUCTION susceptible to teratogens, but this decreases with


embryonic age, as the critical periods for the formation of
Congenital defects, abnormalities of structure or function various organs are passed. The fetus (Day 42) becomes
present at birth, may be caused by genetic or increasingly resistant to teratogenic agents with age,
environmental factors, or a combination of both; in many except for late differentiating structures, e.g. cerebellum,
cases, the causes are unknown. The most common bovine palate, and urogenital system. The majority of genetic
environmental teratogens include toxic plants consumed defects in cattle are inherited as recessives. Approximately
by the dam and maternal-fetal viral infections during 1 in 10 animals carries a lethal or sub-lethal allele.
gestation. Congenital anomalies have been estimated to Disorders of the external genitalia are of particular
occur in 0.2%–5% of calves. In a cattle survey, the concern, due to the impact of these deformities on future
percentages for the occurrence of congenital defects were generations. Atresia ani develops when a dorsal part of the
reported as the musculoskeletal system: 24%, the cloacal plate fails to form. It has been reported as a
respiratory and alimentary tracts: 13%, the central possible genetic defect in Swedish Highland Cattle,
nervous system: 22%, the abdominal wall: 9%, the Holsteins, and other breeds, but the pattern of the
urogenital system: 4%, the cardiovascular system: 3%, the inheritance in cattle is uncertain. Atresia ani is the most
skin: 2%, and others: 4%. Congenital malformation common intestinal defect in sheep and is believed to be
sometimes leads to perinatal mortality, and it may also due to an autosomal recessive gene. In a series of 64 cases
decrease maternal productivity and reduce the value of the of atresia ani in sheep, 42 (62%) were associated with
defective neonates. Severe defects results in abortion of defects of other body systems, especially the urogenital
the calf or a return to service of the calf and cow and musculoskeletal systems. (Ghanem et al. 2004; Kılıç
(Bademkiran et al. 2006; Belge et al.2000; Ghanem et and Sarierler 2004; Magda and Youssef 2007; Newman et
al.2004; Ghanem et al. 2005; Kılıç and Sarierler 2004; al.1999; Rahman et al. 2006; Bademkıran 2008; Loynachan
Magda and Youssef 2007; Newman et al.1999; Noh et et al. 2006).
al.2003; Rahman et al.2006).
Four major types of intestinal atresia have been described.
Developmental defects may be lethal, semi-lethal, or Type I atresia is a mucosal blockage within the intestinal
compatible with life, causing aesthetic defects or having no lumen. In animals with type II atresia, the proximal
effect on the animal. Susceptibility to agents that affect segment terminates in a blind end and the distal segment
development varies with fetal development, but in general beings similarly with 2 ends being joined by a fibrous cord
decreases with gestational age. Before Day 14 of gestation devoid of lumen. Type IIIa atresia is similar to type II
in cattle (period of pre-attachment), the zygote or embryo except that the proximal and the distal blind ends are
is resistant to agents that can cause congenital completely separated and there is a mesenteric defect
malformations (teratogens), but is susceptible to genetic corresponding to the missing segment of intestine.
mutations and abnormalities of chromosome numbers or Animals with type IIIb atresia have a coiled distal segment
structure (chromosomal aberrations). During the of intestine. Type IV atresia involves multiple sites of
embryonic period (Days 14–42), the embryo is highly

Corresponding author: Servet BADEMKIRAN 61


Dicle Universitesi Veteriner Fakultesi Dogum ve Jinekoloji AD, Diyarbakir, Turkey.. Tel: +90 412 248 80 20 Fax: +90 412 248 80 21
e-mail: sebad@dicle.edu.tr
*: Bu araştırma, aynı isimli Yüksek Lisans Tezinden özetlenmiştir
[Servet BADEMKIRAN et al] YYU Vet Fak Derg

atresia (Kılıç and Sarierler 2004; Rahal et al. 2007).


Congenital rectovaginal fistula is characterized by the
communication between the dorsal wall of the vagina and
the ventral portion of the rectum, so that the vulva
functions as a common opening to the urogenital and
gastrointestinal tracts. Usually, the abnormality is
associated with type II atresia ani, in which the rectum
ends as a blind pouch immediately cranial to the
imperforated anus. Clinical signs include passage of feces
through the vulva, vulvar irritation, tenesmus, cystitis, and
megacolon, among others. Recto-vaginal defects may cause
the pneumovagina results from stretched, ruptured,
deformed and horizontal vulva which may introduce fecal
material, urine and air into the vagina (particularly in
older cows) leading to vaginitis, cervicitis, endometritis,
failure of conception and repeated breeding (Cox 1987;
Frank 1981; Ricketts 1991; Roberts 1986 ). Figure 2. The hole of excreted feces in the vagina. (Violet
Pooling of the urine in the cranial portion of the vagina arrows)
(urovagina) often causes infertility in cows (Gilbert 1984; Şekil 2. Dışkının vaginaya geçtiği delik
Jean 1988). The urine and vaginal debris provoke vaginitis,
cervicitis and cause endometritis if they enter the uterus
during estrus. Diagnosis is based on history, clinical signs,
and physical examination. Radiographic examination with
contrast medium infused through the vagina or fistula may
be useful for determining the position of the fistula and
terminal rectum. Two surgical techniques are frequently
used in the treatment of rectovaginal fistula and atresia
ani: in one the fistula is isolated, transected, and the
rectum and vulvae defects are closed separately, followed
by reconstruction of the anus; in the other, the rectum is
transected cranial to the fistulous opening, the affected
segment is removed, and the terminal part of the rectum is
sutured to the anus. Closing the rectovaginal fistula by
numerous purse-string sutures along its length and the use
of plastic adhesive in the treatment of rectovaginal fistula
induced experimentally have also been reported. (Rahal et
al.2007; Farhoodi et al. 2000; Mahler and Williams 2005)
Figure 3. Appearance immediately postoperative after
A crossbred Holstein X Yerli kara (Local breed) heifer, 9
correction of rectovaginal fistula and atresia ani.
month old age to brought to Dicle university, the animal
hospital of veterinary faculty in concideration of lack Şekil 3. Atresia ani ve rekto vaginal fistülün operasyonla
growing problems. We observed the atresia ani (Figure-1) düzeltilmesinden hemen sonraki hali
and recto vaginal fistul defects (Figure-2) on this animal.
Besides, blood samples were taken from animal before 15
minute and one month after surgical operation for
hematologic and biochemical analysis.

Figure 4. After correction of rectovaginal fistula and


atresia ani. Normal area 1 month postoperatively.
Şekil 4. Bölgenin operasyondan bir ay sonraki hali.
Figure 1. Appearance before surgery atresia ani (yellow
arrow) and showing incision line (blue arrows). As a result of the medical examination, proximate 1-1.5 cm
size fistul was found within 5 cm in the side of the left
Şekil 1. Operasyon öncesi atresia ani (Sarı ok ) ve ensizyon dorso-lateral of vulvo-vaginal line (figure-2). Continual
hattının (Mavi oklar) görünümü flowing of feces in fistula hole and the inflammation of
vagina were observed as well.

62
[Congenital Recto Vaginal Fistula] YYU Vet Fak Derg

As a result of discussion the method which suggested by Kilic et al. (2004) state that the history and physical
Rahal (2007) were used. According to this method examination findings in calves with intestinal atresia
epidural anesthesia were applicated and artificial anus frequently are similar. Most affected calves initially will
opened on rectum (Figure-3 and 4). stand and suckle normally after birth. The time to onset of
Usual blood biochemical and hematological variables were clinical signs of disease may vary from 1 to 6 days, calves
observed in the beginning and the end of the surgical with lesions in the proximal segments or with artesia ani
operation (Table-1, Table-2). The increase was observed in may be affected slightly earlier. The principal clinical signs
serum albumin, glucose, calcium, ferritin, total protein and of disease are depression, anorexia, and abdominal
phosphor concentrations (Table.1). Body weight gain and distention. Frequently, the owner has not seen the calf
serum biochemical variables return to the usual values pass meconium or feces. Thick mucus may be passed
consequently turning back of the defecation to normally. through the anus if it is patent or through the vagina in
These results have been hypothesized as the cause of the heifer’s contaminant rectovaginal fistula. In calves with
normal defecation function and passing irritation on atresia ani, the owners may have noticed the defect when
vaginal mucous. We didn’t find any literature about attempting to administer an enema or while obtaining a
biochemical study which has done on atresi and recto rectal temperature reading. For all that the fact of the
vaginal fistula of heifer. atresia-ani and recto vaginal fistula occurs at the same
time and also defecation may cause disappears these
lesions. Because of disappearing of these facts the lesions
Table 1. Biochemical results of animal have been determined by us after checking
Tablo 1. Biyokimyasal sonuçlar complaints such as lack of body weight gain. Since the
clinical signs and physical examination findings were
1 Month After sufficient to establish the diagnosis, radiographic studies
Parameters Before Operation
Operation were not necessary to confirm the disease. However,
Albumin 2.5 3.2 radiographs are considered important to determine the
Calcium 8 9.2 position of the fistula and to differentiate that beforehand
Glucose 52 64 the 4 types of congenital atresia ani (Rahal et al. 2007). We
GOT 148 103 didn’t have facility for radiography therefore we couldn’t
GPT 10 16 check analysis of mega colon.
Fe 56 98
LDH 1500 1120 Some authors (Newman et al.1999; Johnson et al.1980;
Mg 2.2 2.0 Prieur and Dargatz 1984) state that failure of the anal
P 4.3 5.2 membrane to perforate, failure of the bowel to canalize,
Tp 5.4 6.5 failure of the proctodeum to invaginate, and interruption
Alp 252 99 of the blood supply to the anus or to the intestine during
embryonic development can produce atresia ani or
intestinal atresia, respectively. Atresia ani may develop
Table 2. Hematological results when the dorsal part of the cloacal plate fails to form, and
Tablo 2. Hematolojik sonuçlar in females this is occasionally accompanied by a recto
vaginal fistula. The resulting fistula connects the dorsal
Blood 1 Month After
Before Operation wall of the vagina with the ventral portion of the terminal
variables Operation
rectum and provides a path for defecation. Defecation is
WBC 13.30 11.20 inhibited when atresia of the vulva accompanies this
NE 3.91 3.5 lesion. Atresia of the vulva has not been previously
LY 9.11 7.48 reported in calves. Observing of the atresia and recto
MO 0.23 0.20 vaginal fistul results confirm to previous studies.
EO 0.05 0.02
BA 00 00 A genetic basis has been documented for some cases of
RBC 10.81 9.1 atresia ani, but the specific cause in sporadic cases in
Hb 11.9 12.2 domestic species and humans is not always known
HCT 35.7 38.5 (Newman et al.1999; Johnson et al.1980). The heritability
MCV 33.0 39.1 of intestinal atresia is controversial and poorly
MCH 11.4 12.6 understood. Atresia ani has been reported to be a heritable
RDW 30.3 26 condition in pigs and calves (Kilic et al. 2004). However,
PLT 458 714 the own of heifer reported that no dysfunctions was
PDW 4.0 4.5 observed in its own parents.
Some authors (Belge et al.2000; Noh et al.2003; Johnson
DISCUSSION et al.1983; Leipold 1986) reported that the most
anomalies of digestion system were observed as atresia-
Rectovaginal fistula is considered an embryologic failure of ani and et-recti in calves. Besides, the anomalies of
the urorectal septum to separate the cloaca into urinary system such as renal agenesis, polycystic kidney
urethrovesical and rectal segments. Although there are and skeleton system such as cocygeal or sacral vertebral
references of no breed predisposition in dogs presenting agenesis have been observed at the same time in calves.
this disease. In a retrospective study of dogs with atresia But, in our study we observed only atresia-ani and recto-
ani, an increased prevalence in several breeds, including vaginal fistula lesions.
poodles and Boston terriers was observed (Rahal et al.
2007, Johnson et al.1980). However, we didn’t find any As a result, the causes of these defects according as genetic
study has been done on the strain factor on these and environmental factors have not been determined yet.
parameters determined in our study. However, we consider that the lesions of this fact may be
reducing by surgery operation and also this surgery

63
[Servet BADEMKIRAN et al] YYU Vet Fak Derg

operation may improve body weight gain and reduce Kılıç N, Sarıerler M (2004). Congenital ıntestinal atresia in
economic losses caused by the fact. calves: 61 Cases (1999–2003). Revue Méd Vét, 155 (7), 381-
384.

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Fissura Abdominalis Olgusu. Vet Cer Derg,12 (1–2–3–4), 33– Loynachan AT, Jackson CB, Harrison LR (2006). Complete
35. diphallia, ımperforate ani (type 2 atresia ani), and an
Bademkıran S (2008). Bir Buzağıda Kaudal Agenezis Olgusu. FÜ accessory scrotum in a 5-day-old calf. J Vet Diagn Invest,18,
Sağ Bil Enst Derg, (Veteriner) 22 (5), 303 – 305. 408–412.
Belge A, Gönenci R, Selçukbiricik H, Ormancı S (2000). Magda MA, Youssef HA (2007). “Surgical management of
Buzağılarda Doğmasal Anomali Olguları. YYÜ Vet Fak Derg, 11 congenital malformations in ruminants.”.
( 2 ), 23–26. www.priory.com/vet/congenital_malformations_ruminants.ht
m.04.10.2008
Cox JE. (Ed.) (1987). Surgery of the Reproductive System in Large
Animal. Liverpool University Press, Liverpool, pp. 86–190. Mahler S, Wıllıams G (2005). Preservation of the fistula for
reconstruction of the anal canal and the anus in atresia ani
Farhoodi M, Nowrouzian I, Hovareshti P, Bolourchi M, and rectovestibular fistula in 2 dogs. Vet Surg, 34, 148–152.
Nadalian MG (2000). Factors Associated with Rectovaginal
Injuries in Holstein Dairy Cows in a Herd in Tehran, Iran. Newman SJ, Bailey TL, Jones JC, DiGrassie WA, Whittier WD
Preventive Veterinary Medicine, 46, 143–148. (1999). Multiple congenital anomalies in a calf. J Vet Diagn
Invest, 11, 368–371.
Frank ER. (Ed.) (1981). Veterinary Surgery. Publishers and
Distributors, India, pp.287–311. Noh DH, Jeong WI, Lee CS, Jung CY, Chung JY, Jee YH, Do SH, An
MY, Kwon OD, Williams BH, Jeong KS (2003). Multiple
Ghanem M, Yoshida C, Isobe N, Nakao T, Yamashiro H, Kubota congenital malformations in a holstein calf. J Comp Pathol,
H, Miyake Y I, Nakada K (2004). Atresia Ani with Diphallus 129, (4), 313–315.
and Separate Scrota in a Calf: A Case Report. Theriogenology,
61, 1205–1213. Prieur DJ, Dargatz DA (1984). Multiple visceral congenital
anomalies in a calf. Vet Pathol, 21, 452–454.
Ghanem ME, Yoshida C, Nishibori M, Nakao T, Yamashiro H
(2005). A Case of Freemartin with Atresia Recti and Ani in Rahal SC, Vicente CS, Mortari AC, Mamprim M J, Caporalli EHG
Japanese Black Calf. Anim Reprod Sci, 85, 193–199. (2007). Rectovaginal fistula with anal atresia in 5 dogs. Can
Vet J, 48, 827–830.
Gilbert RO, Wilson DG, Levine S A, Bosu WTK (1989). Surgical
management of urovagina and associated ınfertility in a cow. Rahman MM, Khan MSI, Biswas D, Sutradhar BC, Saifuddin
JAVMA 194, 931–942. AKM (2006). Pygomelia or supernumerary limbs in a
crossbred calf. J Vet Sci 7(3), 303–305.
Jean GS, Hull BL, Robertson JT (1988). Urethral extension for
correction of urovagina in cattle-a review of 14 cases. Vet Ricketts SW. (Ed.) (1991). Caslicks Vulvoplasty for Correction of
Surg, 17, 258–262. Pneumovagina in Mares, Equine Practice. Bailliere Tindall,
London, pp. 27–39.
Johnson EH, Nyack B, Aston M (1980). Atresia ani and
rectovaginal fistula in a goat. Vet Med Small Anim Clin, 75: Roberts SJ (Ed.) (1986). Veterinary Obstetrics and Genital
1833–1835 Diseases (Theriogenology). Edwards Brothers, Woodstock,
VT, p. 354, p. 359, pp. 553–556.
Johnson R, Ames NK, Coy C (1983). Congenital ıntestinal
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64
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Atresia Ani: A Congenital Defect & Its Successful Management in Non-Descript


Calf

Article · January 2011


DOI: 10.5455/ijavms.11977

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Chauhanet al.,IJAVMS, Vol. 5, Issue 6, 2011: 520-522


doi: 10.5455/ijavms.11977

Atresia Ani:A Congenital Defect & Its Successful Management in Non-


Descript Calf
P. M. Chauhan*1, V. R. Parmar2, T. P. Patel1,K. B. Thakor1and S. S. Parikh2
Polytechnic in Veterinary Science and Animal Husbandry
Kamdhenu University, Himatnagar – 380001, Gujarat (India)
(1 SRA, Poly. in Vet. Sci. & A. H., Kamdhenu University, Himatnagar and 2 Veterinary Officers)
*Corresponding author email: khanna_vet@yahoo.co.in

Abstract
A case of perineal congenitaldefect (atresia ani) has beenreported in non-
descriptcalf and itssuccessfulmanagementthroughtsurgicalintervension.
Key words: Atresia ani,congenital defect and Non-descript calf.

Introduction
Congenital defects, abnormalities of structure or function present at birth, may be
caused by genetic or environmental factors, or a combination of both; in many cases, the causes
are unknown. The most common bovine environmental teratogens include toxic plants consumed
by the dam and maternal-fetal viral infections during gestation. Congenital malformation
sometimes leads to perinatal mortality, and it may also decrease maternal productivity and reduce
the value of the defective neonates. Severe defects results in abortion of the calf or a return to
service of the calf and cow. Congenital anomalies have been estimated to occur in 0.2%–5% of
calves1.Atresia ani, (imperforate anus) is a congenital abnormality characterized by persistence of
the anal membrane resulting in a thin membrane covering the normal anal canal or is the failure
of the anal membrane to break down8.Mereiet al. 7reported most congenital malformations was
atresia ani and most frequently encountered in male calves and pigs. This report communicates a
case of atresia ani in male calf, which was successfully treated by surgical intervention.

Case history and Clinical observations


A two day old male, non-descript cattle calf was presented at Veterinary
Dispensary, Dhanpur,Dist: Dahod, Gujarat (India)with the history of non – passage of faeces
since birth. After birth, calf was stand and suckle normally but weak. On clinical observation,
closely find with principal clinical signs of dull, depression, anorexia, attempt of defecation and
mild abdominal distention. Also the signs of tenesmus and abdominal pain were observed but
does not voided out the faeces. The case was diagnosed as atresia and handover for surgical
intervention.
ATRESIA ANI IN NON-DESCRIPT CALF

Treatment and Discussion


The calf was controlled in dorso-ventral position with its hindquarter raised high
from the ground to minimize the staining during operation and restrained properly to immobilize.
The perineal reconstruction below the tail was prepared for aseptic surgery. Local infiltration
anesthesia was performed by using injection 2% lignocaine hydrochloride (Zylocaine,
LaboratePharmaceuticals Ltd., Ahmedabad, India) solution at the proposed site of incision. In
present
case, abdomen was compressed initially and developed a bulge at the perineal area. Then the
circular incision was made upon the bulge of the anus and the circular piece of incised skin was
removed. The rectum was exposed after dissection of the perineal muscles therein and mild
bleeding was occurring. The blind end of the rectum was brought to the level of anal sphincter (at
incised skin) and fixed to the perineum after duly snipping the tip of the blind end of rectum
meant for evacuation of the contents (muconium). This was done by putting four stitches
(dorsally, ventrally and laterally on both sides). The circumference of the rectal opening was
sutured by application of interrupted sutures by using black braided silk # 2 between rectal
mucosa and skin to make a permanent anal orifice and calf was stand normally with minimum
tenesmus immediate after surgery (Figure). Post-operatively, Gentamicin@3ml for 5 days and
Meloxicam@2ml for 3 days were administered intramuscularly, followed by routine dressing
with liquid Metrodin and application of fly repellent ointment (Gamacen veterinary cream,
Centurian Laboratories Pvt. Ltd., Baroda) at the operative site till recovery. The sutures were
taken off on 11th day post-operatively.

Congenital defects and abnormalities presented in this study were recorded as


sporadic cases and it may be due to genetic or environmental forces, or a combination of both,
during the process of embryogenesis10. Affected calves initially will stand and suckle normally
after birth. The time to onset of clinical signs of disease may vary from 1 to 3 days. On collection
of history of the owner did not see the calf passing the muconium or faeces was the main
observation. The principal clinical signs of present case were straining, colic, tenesmus,
depression, anorexia with moderate abdominal distention and not passing meconium. Atresia

IJAVMS, Vol. 5, Issue 6, 2011: 520-522 doi: 10.5455/ijavms.11977


ATRESIA ANI IN NON-DESCRIPT CALF

anisimply can be diagnosed by visual inspection of anal opening at perineal region or by limited
digital palpation if a vestigial anal opening is present13. If, calf suffering with condition atresia ani
needed immediate surgical intervention3which improve body weight gain and reduce economic
losses caused by the fact.
The calf showed marked improvement in defecation with minimum tenesmus and
active in nature within 3rd day of surgery and unevenful recovery occur within 11thpost operative
day. Four major types (type – I, II, IIIa&IIIb and IV) of intestinal atresia have been described by
Rahaletal.11. Atresia ani is a type I atresia in which the mucosal blockage within the intestinal
lumen. The present case of atresia ani of intestinal atresia is the simple form of agenesis without
involving the other parts and similar findings in calves12,13 and in kid 5,12were reported.Some
authors2,4,6,9 reported that the most anomalies of digestion system were observed as atresia-ani and
et-recti in calves. It was also found with other congenital defects reported by various authors like
anus vaginalis4, atresia aniet recti, atersiaani with vaginal-urinary bladder agenesis7, atresia ani
with scrotal anomaly5 and congenital recto-vaginal fistula with atresia ani1. But, in our study we
observed atresia-ani alone. If the rectum ends blindly as a cul- de sac a short distance cranial to
the anal membrane, the condition is called rectal atresia8.
References
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IJAVMS, Vol. 5, Issue 6, 2011: 520-522 doi: 10.5455/ijavms.11977

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