Case report

Perineal hernia, surgical repair

Date:

Place:

Data provided by:

History

A 47 years old captive female Asian elephant, working in the logging industry, displayed a large bulging mass below the tail since 10 years, which increased in diameter from 4 inches to 22 inches. At ultrasonographic examination it was diagnosed as a cervico-vaginal prolaps. Better described as perineal hernia with cervico-vaginal involvement (WS). The elephant did not suffer of any limitations in relationship to this condition. Previous cases in other female elephants of the company had died of this condition. As the mass was increasing in size, it was decided to perform a correcting surgery. At the time of surgery the animal was in healthy condition. 

Treatment

A standing sedation procedure with xylazine and ketamine was used.

A incision of the skin and the vaginal vestibule was made 7 inches lateral to the perineal midline, allowing manual passage to explore the subcutaneous area. A catheter (1/4 inch diameter) was advanced into the  uterus (or was it into the urthra?) and the uterus (bladder?) could be drained. The catheter was replaced by a larger catherter (½ inch) and more fluid, which contained several stones was drained. The the cervix uteri and the vagina (bladder?) were pushed back into the pelvic cavity through the herniated pelvic diafragm using the arm that was advanced into the vagina .  

The vaginal vestibule was closed using a continuous catgut suture. The skin was closed using 3 continuous nylon matrass sutures. At each knot a protecting plastic plate was placed underneath the knot to protect the skin from perforation by the nylon suture. Finally, a wooden block with a foamy protection layer was tightly tied to the (formerly) bulging area using ropes around the elephants body.

Treatment results

The ropes and the supporting block remained in place and the hernia did not recur between surgery and publication of this paper. However, it is not know for how long this animal stayed without recurrence.