Indo-Am. J. Agric. & Vet. Sci., 2014 ISSN M Gokula 2321 9602 Krishnan www.iajavs.com et al., 2014 Vol. 2, No. 3, September 2014 2014 Meghana Publications. All Rights Reserved Case Report SURGICAL MANAGEMENT OF VAGINAL HYPERPLASIA AND PROLAPSE IN A PUG BITCH M Gokula Krishnan 1 *, I Nagarajan 1 and C S Arunaman 1 *Corresponding Author: M Gokulakrishnan drgocool_vet@yahoo.co.in Vaginal hyperplasia/prolapse occurs uncommonly in young bitches, during proestrus andestrus as a result of elevated estrogen level A two year old pug was brought with a history of prolapse of the vagina for the past two days. A circumferential incision was made around the hyperplastic prolapsed mass and the mass was amputated. The proximal and the distal edges of the wound in the mucous membrane after amputation were sutured with chromic catgut 1-0 in a simple continuous pattern, taking care not to include the urethra in the suture line.medical treatment is not advised as vaginal prolapse recurs frequently, if not treated surgically. Surgical treatment depends on the extent of the fold prolapse, breeding status and occurrence of prolapse during estrus or at the end of pregnancy. Amputation is the treatment of choice in bitches with a circumferential vaginal prolapse, which extends outside the vulvar lips. Keywords: Vaginal hyperplasia, Prolapse, Elevated estrogen level, Surgical treatment INTRODUCTION Vaginal prolapse is the protrusion of the vaginal wall (usually the ventral wall) through the vulva (Alan et al., 2007). Vaginal hyperplasia/prolapse occurs uncommonly in young bitches, during proestrus and estrus as a result of elevated estrogen level during the first (or) the second fol licu lar phase an d may re cur at e ach subsequent estrus, if the bitch is not treated properly (Sarrafzadeh et al., 2008). In case of vaginal prolapse, there is 360 degrees protrusion of the tissue lining the vagina, whereas with vaginal hyperplasia the problem originates from the stalk of the lining the floor of the vagina (Rushmer, 1980). This report presents the surgical management of vaginal hyperplasia and prolapse in a Pug bitch. HISTORY AND OBSERVATIONS A two year old pug was brought to Veterinary University Peripheral Hospital, MMC with a history of prolapse of the vagina for the past two days. A progressive increase in the vaginal prolapse was observed by the owner from the date of mating. The bitch was previously treated by a local veterinarian but was unsuccessful. On clinical examination the mass was found to be doughnut shaped, odematous and ulcerated. 1 Veterinary University Peripheral Hospital, Madhavaram Milk Colony, Chennai-51, Tamilnadu Veterinary and Animal Sciences University. 83
Indo-Am. J. Agric. & Vet. Sci., 2014 M Gokula Krishnan et al., 2014 TREATMENT AND DISCUSSION The animal was prepared for surgery following premedication with atropine sulphate and xylazine @ 0.04 mg/kg and 2 mg/kg body weight intramuscular respectively. Anaesthesia was induced with a combination of ketamine and di azepam @ 5 mg/kg and 0.5 mg/ kg intravenously. The dog was placed on ventral recumbency with the hind quarters elevated. The prolapsed mass was washed with normal saline and the surgical area was drapped (Figure 1). External urethral orifice was identified and was catheterized. A circumferential incision was made around the hyperplastic prolapsed mass and the mass was amputated. The proximal and the distal edges of the wound in the mucous membrane after amputation were sutured with chromic catgut 1-0 in a simple continuous pattern, taking care not to include the urethra in the suture line (Figure 2). A tamponade was kept in place for 2 h to arrest hemorrhage. Tramadol @ 2 mg/kg intravenously was given as postoperative analgesic. Post operative antibiotic amoxicillin and cloxacillin @ 20 mg/ kg intramuscular was gi ven for 7 days. Lubricating jelly and an Elizabeth collar was advised for a w eek. The ani mal had an uneventful recovery without any post operative complication. Figure 1 Figure 2 Breed and age factor accounts for nearly 80% of occurrence of vaginal prolapse in bitches. Etiology of the condition is complex but hereditary weakness of the perivaginal tissue is a pre disposin g factor. Te nesmus, forced separation during coitus as may be the cause in the present case and size discrepancy between the breed partners also have a role in vaginal prolapse (Deniz Nak et al., 2008). The protruding mass of the prolapse is vulnerable to trauma, ulceration, and self-mutilation and can interfere with natural mating. Medical treatment is not advised as vaginal prolapse recurs frequently, if not treated surgically. Surgical treatment depends on the extent of the fold prolapse, breeding status and occurrence of prolapse during estrus or at the end of pregnancy. Amputation is the treatment of choice in bitches with a circumferential vaginal prolapse, which extends outside the vulvar lips (Johnston et al., 2001) as in the pre sent case. I f th e protru sion is not circumferen tial, vaginal prolapse w ill spontaneously resolve when the estrogen influence diminishes during diestrus. Animal with vaginal prolapse/hyperplasia should not be used for breeding because the disease has a familial predisposition. Severe acute and long standing vaginal prolapse may be affected by 84
Indo-Am. J. Agric. & Vet. Sci., 2014 M Gokula Krishnan et al., 2014 hemorrhage, infection or necrosis of the prolapsed tissue. Surgical resection of the devitalized tissue is necessary for the prevention of sepsis and self mutilation as performed in this case. Lubricating jel ly, anti biotic and glucocorticoid ointment, an Elizabeth collar are to be advised (Post et al., 1991) as done in the present case. Hemorrhage may occur following amputation of the protruding edematous tissue, but it is self limiting if good surgical technique is adopted. REFERENCES 1. Alan M, Cetin Y, Sendag S and Eski F (2007), Anim Reprod Sci, Vol. 100, pp. 411-414. 2. De niz Nak, Yavuz Nak and Guln az Yilmazbas (2008), Bull Vet Inst, Vol. 52, pp. 397-398. 3. Johnston S D and Kustritz M V R (2001), Canine and Feline Theriogenology, W.B. Saunders Company, London, pp. 242. 4. Post K, Van Haaften B and Okkens A C (1991), Can. Vet. J., Vol. 32, pp. 35-37. 5. Rushmer R A (1980), Vaginal Hyperplasia and Uterine prolapse, In: Kirk R W (Ed.), Current Veterinary Therapy VII, Small Animal Practice, Philadelphia: WB Saunders co., pp. 1222-1224. 6. Sarrafzadeh-Rezaei F, S aifzadeh S, Mazaheri R and Behfor M (2008), Anim Reprod Sci, Vol. 106, p. 199. 85