Vaginal prolapse with urinary bladder incarceration and consecutive irreducible rectal prolapse in a dog
© The Author(s) 2016
Received: 26 April 2016
Accepted: 13 September 2016
Published: 22 September 2016
True vaginal prolapse is a rare condition in dogs and it is occasionally observed in animals with constipation, dystocia, or forced separation during breeding. If a true prolapse occurs, the bladder, the uterine body and/or distal part of the colon, may be present in the prolapse.
A 2-year-old intact non pregnant Central Asian Shepherd dog in moderate condition, was presented for a true vaginal and rectal prolapse. The prolapses were confirmed by physical examination and ultrasonography. Herniation of the urinary bladder was identified within the vaginal prolapse. The necrotic vaginal wall was resected, the urinary bladder was reduced surgically and fixed to the right abdominal wall to prevent recurrence. Rectal resection and anastomosis was necessary to correct the rectal prolapse. Recurrence of the prolapses was not observed and the dog recovered completely after the surgical treatment.
In our opinion, extreme tenesmus arising from constipation may have predisposed to the vaginal prolapse with bladder incarceration and secondarily to rectal prolapse. In the young female dog, true vaginal prolapse with secondary involvement of the urinary bladder and irreducible rectal prolapse is an exceptionally rare condition.
The most common causes of vaginal/vestibular masses in the bitch are vaginal prolapse, vaginal neoplasia, and urethral neoplasia protruding into the vaginal vault . True vaginal prolapse is a rare condition in dogs and cats, but it is occasionally found in animals with constipation, dystocia, or forced separation during breeding [2, 3].
When a true prolapse occurs, other structures such as the bladder, the uterine body and/or the descending colon may be present within the prolapse . In four of five reported canine cases of vaginal prolapse, other structures had herniated into the vagina [2, 3, 5] with development of urinary bladder incarceration in two cases [6, 7].
In case of rectal prolapse, all layers of the rectum protrude through the anal orifice as an elongated, cylindrical mass. Prolapse usually develops secondary to tenesmus from urogenital or anorectal disorders associated with predisposing conditions, including gastrointestinal nematodiasis; typhlitis; colitis; proctitis; tumors of the colon, rectum, or anus; rectal foreign bodies; perineal hernia; cystitis; prostatic disease; urolithiasis; and dystocia .
This case report describes a true vaginal prolapse with bladder incarceration combined with an irreducible rectal prolapse in a young, non-pregnant, large breed dog. To our knowledge, only one case of this condition has been reported , but the rectal prolapse was reducible in that case.
During the examination, the dog was not particular sensitive to palpation and manipulation of the prolapsed masses. The temperature, peripheral pulse, and respiratory rate were within normal ranges. Hematology including complete blood count and serum biochemistry profiles. All parameters were within normal range.
The dog was administered cefazolin preoperatively (22 mg/kg BW intravenously; Cefazolin, Sandoz GMBH, Austria). General anesthesia was induced with propofol (4 mg/kg BW; Braun, Melsungen, Germany) and maintained with isoflurane (Forane; Abbott, Romania) delivered in 100 % oxygen. Lumbosacral analgesia was carried out with morphine (0.1 mg/kg BW; Morfină, Sicomed S.A., Bucharest, Romania). Lactated Ringer’s solution was administered during surgery (20 ml/kg BW per hour; Soluție Ringer Lactat, Braun Medical, Timiș, Romania).
The rectal mucosa was cleaned with warm isotonic NaCl solution and repositioning was attempted, but unsuccessful despite multiple attempts to gently reduce the prolapse. The tissue viability was questionable because of oedema and necrosis, so rectal resection and anastomosis was judged necessary. The dog was again placed on the padded rectal stand, and the perineal region was prepped and draped for surgery. A test tube was introduced into the rectum to aid in suture placement and prevent fecal contamination during surgery. The prolapsed tissue was resected 2 cm from the anus. The two ends were full thickness anastomosed with a single layer of simple interrupted, synthetic, absorbable monofilament PDS sutures.
Amoxicillin–clavulanic acid (25 mg/kg BW bid; Synulox; Zoetis, UK) and carprofen (2 mg/kg BW bid; Ricarfa, KRKA, București, Romania) were administered after surgery for 6 days.
The dog recovered completely after the surgery. No recurrence of the prolapsed vagina or rectum and no retroflexion of the urinary bladder occurred during 2 months follow-up.
Vaginal edema in bitches commonly develops in proestrus and estrus and in the first three estrous cycles in younger bitches . This condition must be differentiated from vaginal prolapse, e.g. by digital vaginal exploration. The incidence of prolapsed vagina is higher in large-breed dogs [1, 9], but true vaginal prolapse is extremely rare in dogs and cats  and mainly occurs during parturition or shortly after . Because the dog in the study was a young, non-pregnant female and it was not separated by force during breeding, constipation (although not reported) could be a possible predisposing condition as reported in other studies [2, 3].
The median ligament (lig. vesicae medianum) and the lateral ligaments (lig. vesicae laterales) of the bladder hold the organ in its normal position. The ligaments are made up of double layers of peritoneum separated by intercalated blood vessels, nerves, lymphatics, and adipose tissue, as well as by the ureters, deferent ducts, and vestiges of embryonic structures . In a previous report , similar to the case in this study, the authors speculate that excessive tenesmus because of the rectal prolapse resulted in increased intra-abdominal pressure, rupture of the ligaments, caudal displacement of the urinary bladder, and protrusion of the bladder into the vulvar cleft. However, in our case, rectal prolapse was secondary to vaginal prolapse. Therefore, in our case, excessive straining and tenesmus due to the vaginal prolapse and bladder retroflexion may have resulted in disruption of the supporting ligaments of the colon.
CAO, LVB and LO performed the surgery and drafted the manuscript. CPP carried out the anesthesia. MAT and CC described the gross appearance of the prolapsed organs and participated in the manuscript design. SB, JM and GS revised the manuscript. All authors participated in writing the manuscript. All authors participated in writing the manuscript. All authors read and approved the final manuscript.
Funding was provided by European Social Fund, Human Resources Development Operational Programme 2007-2013 (Grant No. POSDRU/159/1.5/S/136893).
The authors declare that they have no competing interests.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
- Manothaiudom K, Johnston SD. Clinical approach to vaginal/vestibular masses in the bitch. Vet Clin N Am Small Anim Pract. 1991;21:509–21.View ArticleGoogle Scholar
- Alan M, Cetin Y, Sendag S, Eski F. True vaginal prolapse in a bitch. Anim Reprod Sci. 2007;100:411–4.View ArticlePubMedGoogle Scholar
- Memon MA, Pavletic MM, Kumar MS. Chronic vaginal prolapse during pregnancy in a bitch. J Am Vet Med Assoc. 1993;202:295–7.PubMedGoogle Scholar
- Wykes PM. Diseases of the vagina and vulva in the bitch. In: Morrow DA, editor. Current therapy in theriogenology. London: Saunders; 1986. p. 476–81.Google Scholar
- McNamara PS, Harvey HJ, Dykes N. Chronic vaginocervical prolapse with visceral incarceration in a dog. J Am Anim Hosp Assoc. 1997;33:533–6.View ArticlePubMedGoogle Scholar
- Canatan HE, Ergin I, Polat IM, Yazlik MO. Unusual cases of vaginal prolapse concurrent with cystocele in two dogs. Revue Méd Vét. 2015;166:43–6.Google Scholar
- Besalti O, Ergin I. Cystocele and rectal prolapse in a female dog. Can Vet J. 2012;53:1314–6.PubMedPubMed CentralGoogle Scholar
- Aronson LR. Rectum, anus, and perineum. In: Tobias KM, Johnston SA, editors. Veterinary surgery: small animal. St. Louis: Saunders; 2011. p. 1573.Google Scholar
- Johnston SD, Kustriz MVR, Olson PNS. Canine and feline theriogenology. 1st ed. London: Saunders; 2001. p. 225–73.Google Scholar
- Adin CA. Vagina, vestibule, and vulva. In: Tobias KM, Johnston SA, editors. Veterinary surgery: small animal. St. Louis: Saunders; 2011. p. 1899.Google Scholar
- Okkens AC. Vaginal edema and vaginal fold prolapse in the bitch, including surgical management. 2001. http://www.ivis.org/advances/Concannon/schaefers/IVIS.pdf?q=ivis. Accessed Dec 2015.
- Evans HE, de Lahunta A. Miller’s anatomy of the dog. 4th ed. St. Louis: Saunders; 2012.Google Scholar