Hérnia perineal no cão
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2018-12-04
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A elaboração desta dissertação de mestrado foi baseada no estágio curricular na área de cirurgia no Hospital Veterinari Canis em Girona, Espanha. A hérnia perineal (HP), resulta do enfraquecimento muscular do diafragma pélvico que conduz à separação dos músculos e fáscia, quando estes se tornam incapazes de conter a parede retal, o conteúdo abdominal e pélvico pode deslocar-se da sua localização anatómica normal, sofrendo herniação para a região perineal subcutânea. As hérnias perineais representam uma patologia comum na área da cirurgia de tecidos moles em Animais de Companhia, mais frequentemente em cães machos, não castrados com idade superior a 6 anos. Na maioria das vezes a sua apresentação clínica não requer intervenção cirúrgica urgente, no entanto, em situações mais graves, que incluam encarceramento de órgãos como a bexiga e/ou próstata, esta pode ser considerada uma emergência médica. A HP pode ser unilateral ou bilateral e apesar desta condição estar bem documentada e estudada a sua etiopatogenia ainda não está bem compreendida. Posto isto, diversas teorias têm sido propostas e diferentes estudos têm sido realizados, na tentativa de clarificar melhor os mecanismos que estão envolvidos no seu desenvolvimento. O diagnóstico da HP é baseado na história pregressa, nos sinais clínicos, no exame físico sobretudo com recurso ao toque retal, sendo que em alguns casos se poderá realizar exame radiográfico e ainda ultrassonografia. A radiografia abdominal pode ser útil para avaliar o conteúdo da HP, as dimensões da próstata e para averiguar se houve a deslocação da bexiga para o saco herniário. A uretrocistografia é útil para avaliar a integridade do trato urinário inferior e determinar a posição da bexiga. O presente estudo teve como objetivo abordar fatores relevantes para o conhecimento da hérnia perineal, como a incidência, os sinais clínicos, os melhores métodos de diagnóstico e sobretudo as diferentes técnicas cirúrgicas que foram desenvolvidas ao longo dos anos para o seu tratamento, assim como as complicações pós-cirúrgicas mais frequentes e taxas de recidiva. Durante o estágio foram acompanhados sete cães diagnosticados com HP, dos quais um apresentava HP bilateral e quatro foram intervencionados pelo método de herniorrafia clássico, enquanto três dos animais foram sujeitos a uma combinação entre a técnica clássica e a aplicação de malha de polipropileno.
The elaboration of this master's thesis was based on the curricular internship in the area of surgery at the Veterinari Canis Hospital in Girona, Spain. Perineal hernia results from muscle weakness of the pelvic diaphragm leading to separation of the muscles and fascia, when they become unable to contain the rectal wall, the abdominal and pelvic contents can move from their normal anatomical location, suffering herniation to the subcutaneous perineal region. Perineal hernias represent a common pathology in the area of soft tissue surgery in small animals, most often in uncastrated male dogs older than 6 years. In most cases, its clinical presentation does not require urgent surgical intervention; however, in more severe situations, including incarceration of organs such as the bladder and / or prostate, it may be considered a medical emergency. Perineal hernia may be unilateral or bilateral and although this condition is well documented and studied, its etiopathogenesis is still not well understood. Having said this, several theories have been proposed and different studies have been carried out in an attempt to better clarify the mechanisms that are involved in their development. The perineal hernia diagnosis is based on the previous history, clinical signs, physical examination and above all with the rectal touch, and in some cases radiography and ultrasonography may be performed. Abdominal radiography may be helpful in evaluating the perineal hernia content, the prostate dimensions and in order to ascertain whether the bladder has moved to the hernia sac. Uretrocistography is useful for assessing the integrity of the lower urinary tract and determining the bladder position. The present study aimed to address factors relevant to the knowledge of perineal hernia, such as the incidence, clinical signs, the best diagnostic methods and especially the different surgical techniques that have been developed over the years for its treatment, as well as the most frequent postoperative complications and relapse rates. During the internship, seven dogs diagnosed with perineal hernia were followed, of which one present a bilateral perineal hernia and five were operated by the classical herniorrhaphy method, while two were subjected to a combination between the classic technique and the application of polypropylene mesh.
The elaboration of this master's thesis was based on the curricular internship in the area of surgery at the Veterinari Canis Hospital in Girona, Spain. Perineal hernia results from muscle weakness of the pelvic diaphragm leading to separation of the muscles and fascia, when they become unable to contain the rectal wall, the abdominal and pelvic contents can move from their normal anatomical location, suffering herniation to the subcutaneous perineal region. Perineal hernias represent a common pathology in the area of soft tissue surgery in small animals, most often in uncastrated male dogs older than 6 years. In most cases, its clinical presentation does not require urgent surgical intervention; however, in more severe situations, including incarceration of organs such as the bladder and / or prostate, it may be considered a medical emergency. Perineal hernia may be unilateral or bilateral and although this condition is well documented and studied, its etiopathogenesis is still not well understood. Having said this, several theories have been proposed and different studies have been carried out in an attempt to better clarify the mechanisms that are involved in their development. The perineal hernia diagnosis is based on the previous history, clinical signs, physical examination and above all with the rectal touch, and in some cases radiography and ultrasonography may be performed. Abdominal radiography may be helpful in evaluating the perineal hernia content, the prostate dimensions and in order to ascertain whether the bladder has moved to the hernia sac. Uretrocistography is useful for assessing the integrity of the lower urinary tract and determining the bladder position. The present study aimed to address factors relevant to the knowledge of perineal hernia, such as the incidence, clinical signs, the best diagnostic methods and especially the different surgical techniques that have been developed over the years for its treatment, as well as the most frequent postoperative complications and relapse rates. During the internship, seven dogs diagnosed with perineal hernia were followed, of which one present a bilateral perineal hernia and five were operated by the classical herniorrhaphy method, while two were subjected to a combination between the classic technique and the application of polypropylene mesh.
Descrição
Dissertação de Mestrado em Mestrado Integrado em Medicina Veterinária apresentada à Universidade de Trás-os-Montes e Alto Douro
Palavras-chave
hérnia perineal , cães , herniorrafia , cirurgia , tratamento