Perineal hernia

Compiled by Willem Schaftenaar, 2020

Definition: A perineal hernia is a disruption of the pelvic diaphragm musculature that allows contents of the pelvic canal and/or abdominal cavity to herniate into the perineal subcutaneous tissues. In elephants this condition presents as a large bulging mass below the tail. 

Diagnose

1. Pressure on the bulging area sometimes results in urination. This is suggestive for the presence of the urinary bladder in the perineal subcutaneous space.

 

2. Rectal palpation: if the urinary bladder is present in the perineal subcutaneous space, the bladder may empty when pression is used by the hand through the rectal wall.

3. Transrectal and transcutaneous ultrasonographic examination: visualization of the urinary bladder, cervix uteri or parts of the uterus in the subcutaneous space definitely confirms a hernia perinealis.

History

The cause of this condition in elephants is unknown. Complications: insufficient emptying of the urinary bladder may predispose for urine retention. There are no reports of urinary infection in elephants due to this condition.

The first report on a perineal hernia dates from 1967 (Stehlik, 1967): a 20 yr-old female Asian elephant showed an over time increasing swelling in the perineal area, which aggravated each time the elephant had to stand on its hind legs for performance. Kuntze described a second case in 1989 and the author hypothesized that the hernia in this 6-yr-old circus Asian elephant might have been caused by the act that forced the elephant to stand on its hind legs, while supporting its front legs on another elephant (Kuntze 1989). During this act, a 30 cm diameter ball-shaped swelling was noticed in the perineal area. As soon as the elphant stood on 4 legs, the swelling disappeared. Four years after the elephant had stopped this circus act, the swelling had disappeared.

Hernia perinealis in an adult Asian elephant in a North American zoo.

Treatment

In the 4 cases that I am aware of, clinical signs were limited and did not cause discomfort to the elephant. These elephants were not treated for this condition. There is only one report about surgical repair of the perineal hernia, as the perineal subcutaneous mass became larger over a period of 10 years (Myanmar, 2016).

Treatment results

In one case in a 4 years old female Asian elephant, only the urinary bladder was involved. This case was not treated and the condition resolved within the next 3 years (Bernhardine, 1988, Rotterdam Zoo).

The surgical repair in the Myanmar case was reported as a succesful intervention. Click here for the report.

References

  • Kuntze A. 1989. Arbeitsbedingter Krankheitsbilder: Hernia perinealis, bursitis praepatellaris und Tyloma Olecrani bei Zirkuselephantinnen (Elephas maximus). 1989. 31st International Symposium on Diseases of Zoo and Wild animals, Dortmund (Germany) 1989, 185-187.

  • Oo Z.M., et al. 2016 Surgical treatment of a cervico-vaginal prolapse in an Asian elephant in Myanmar. Gajah 44, 36-39 

  • Stehlik M. 1967. Über zwei Fällen von Fussleiden, einen Fall von Volvulus und einen Fall von Hernia Perinealis bei indischen Elephanten. Nineth International Symposium on Diseases of Zoo and Wild animals, Prague 243-247.