Correção de divertículo retal através de prolapso retal iatrogênico em cão : relato de caso

Abstract

Rectal diverticulum associated with perineal hernia has been reported by several authors through the years. It’s a rare anomaly which consists in rectal wall distension in consequence of compression by compacted feces. Without the effective repair of both defects the rectal sacculation could lead to incomplete defection with feces compaction and disquezia, resulting in hernia recurrence. It has been described some techniques to repair these defects, but the literature is still scarce. This paper describes the successful surgical repair of these two anomalies in a dog through an adapted technique from a pre-existing procedure. Cases: This study reports the surgical treatment of a dog which presented perineal hernia and rectal diverticulum diagnosed separately, and because of that, needed two separated procedures. The patient was admitted due to disquezia, disuria and swelling in perianal region. Complete blood count, biochemical tests and abdominal ultrasound were performed allowing us to diagnose the perineal hernia. It was performed a standard procedure [7] to repair this defect and after a week the patient were discharged and well, with no more clinical signs of the hernia. After two months it was admitted again with the same clinical signs, but during the digital evaluation of the rectal wall it was detected a mild distension, leading to the suspicion of a possible case of sacculation that was confirmed later by contrasted X-ray. This exam showed a significant quantity of compacted feces in the rectum, inside of a sac structure. Although, it was not observed any signs of hernia recurrence. The surgical procedure made to correct this defect was adapted from a pre-existing surgical technique [5], creating an iatrogenic rectal prolapse until the diverticulum was totally exposed and removed. The closure was made by simple separated sutures with nylon 3-0 through the entire extension of the excised rectum in 360°. Once the incision had been entirely closed, the intestinal segment was manually repositioned in its anatomical normal place. An anal suture was needed to avoid a spontaneous rectal prolapse after the surgery. The patient remained in admission though a week receiving intravenous medicine and laxative to improve its condition and after this period it was discharged, presenting no signs of discomfort, disquezia or others caused by the diverticulum or perineal hernia. The patient started to present disquezia again after 3 months of the surgery, leading us to increase the dosage of the laxative. After this medicine dosage adaptation, the patient condition stabilized and remain this way as far as we know. Discussion: This adapted procedure creating an iatrogenic prolapse allowed the repair of a rare defect with successful result, despite the late diagnose. It did not interfere in the success of the previous surgery to correct the perineal hernia. It is known that this procedure can also have some complications, such as the continuous use of laxative in case of disquezia and disquezia itself. Although the rectal diverticulum and the perineal hernia were diagnosed separately, the outcome of the surgical procedure was completely effective. Nevertheless, it is a surgical technique that can be used in cases like this, but still need more research. There is also need of studies about these two defects occurring simultaneously and other surgical procedures to repair them successfully.