ttp://www.bsava.com
CASE REPORT
Transrectal bladder prolapse secondary to pelvic fracture in two dogs L. Z. Crivellenti*,†, M. P. Silveira†, A. N. Silva†, S. Borin-Crivellenti*, T. M. M. Raposo* and D. K. Honsho† *Department of Veterinary Clinical and Surgery, Universidade Estadual Paulista (UNESP), Jaboticabal, São Paulo CEP 14884-900, Brazil †Department of Veterinary Clinical and Surgery, Franca University, Franca, São Paulo CEP 14404-600, Brazil
This report describes the exteriorisation of the urinary bladder in two dogs as a result of a laceration of the rectum from a traumatic pelvic fracture. Clinical examination and contrast radiography of the bladder were used as diagnostic tools. Both patients were treated with exploratory laparotomy, where traction of the bladder was utilised to pull the bladder through the traumatic rectal laceration allowing the organ to return to its normal anatomical position. This procedure was followed by surgical reconstruction of the rectum, resulting in effective resolution of each case. Journal of Small Animal Practice (2014) DOI: 10.1111/jsap.12212 Accepted: 21 February 2014
INTRODUCTION In dogs, acquired changes in the urinary bladder’s anatomical position are uncommon (Arbeiter & Bucher 1994). It has been most commonly described associated with two major conditions: perineal hernia in geriatric dogs due to weakness and separation of pelvic diaphragm components (White & Herrtage 1986, Niles & Williams 1999, Brissot et al. 2004), and increased intra-abdominal pressure during parturition in females, which culminates in vesical prolapse due to excessive straining or following trauma to the vagina (Mcnamara 1997, Toniollo et al. 2004, Hayes 2004, Prassinos et al. 2010). In both conditions, displacement of other abdominal organs, including the small intestines and uterine body, has been reported (Mcnamara 1997, Prassinos et al. 2010). Exteriorisation of the urinary bladder is most commonly described in pregnant sows and deer (Toniollo et al. 2004). In these species, it is generally associated with rupture of the perineal wall between the vulva and the anus (Heinritzi & Hammerl 1987, Schulz & Bostedt 1995). To the author’s knowledge, reports of bladder prolapse with exteriorisation of the urinary bladder in dogs have not yet been described in the veterinary literature. This report describes two cases of prolapse of the urinary bladder in the dog secondary to rectal laceration after motor vehicle trauma.
CASE HISTORIES Case 1 A three-month-old male dachshund dog was presented to the Veterinary Hospital of Franca University (UNIFRAN), Brazil 10 hours after being hit by a car. Journal of Small Animal Practice © 2014 British Small Animal Veterinary Association
Physical examination revealed reluctance to walk on the hindlimbs (but without loss of voluntary movements and nociception). Blunt injury to the inguinal region, marked abdominal sensitivity at the hypogastric area with mild oedema, and externalisation of a thin-walled, fluid-filled sac through the anus, which grossly resembled the urinary bladder (Fig 1A) were also present. Survey radiographs and positive contrast retrograde urethrocystogram revealed displacement of the urinary bladder from its usual anatomic position to the perineal region, passing through the caudal portion of the rectum. Bilateral fractures of the body of the ilium and of the pubic bone, and left sacroiliac joint were noted (Fig 1B). Urethral catheterisation was easily performed and renal values (creatinine and urea) were within their respective reference intervals. Therefore, it was presumed that functional urinary tract obstruction was not present. While under general anaesthesia with an epidural of 0·22 mg/ kg lidocaine 2%, the bladder was decompressed with a urinary catheter and the patient underwent exploratory laparotomy with reintroduction of the urinary bladder into its usual anatomical position. This was performed by passing the urinary bladder back through the opening of the rectum caused by the traumatic laceration. Gross faecal contamination was not noted. The bladder appeared grossly viable and was easy to reduce without the need to expand the rectal tear. The rectal laceration was sutured using a single, full-thickness layer with a simple interrupted pattern with 4-0 nylon suture. Suture bites were spaced 2 to 3 mm from the incision edges and 3 mm apart. Serosal patch reinforcement was used to prevent postoperative leakage. Following this procedure, the abdominal cavity was lavaged with saline solution and the abdomen was closed in a routine fashion. 1
L. Z. Crivellenti et al.
A
B
FIG 1. (A) Externalisation through the anus of a fluid-filled thin sac, which grossly resembled the urinary bladder. The bladder cannot be identified in its usual anatomic position. In (B) the prolapsed bladder can be evidenced through positive contrast retrograde urethrocystography. Aligned fractures were observed in the body of ilium (bilateral) and pubis. Left sacroiliac luxation was also observed
During the postoperative period, analgesia was provided with 0·3 mg/kg morphine subcutaneously (sc; as needed) and the patient was maintained with a polyvinyl chloride urethral catheter for 3 days to maintain an empty bladder and avoid distension or pain. The patient was able to urinate normally after catheter removal. Defaecation was normal two days after surgery. A dose of 30 mg/kg cephalexin (Cefalexina; Neo Química) orally every 12 hours and 10 mg/kg metronidazole (Flagyl; Sanofi Aventis) orally every 12 hours were prescribed for 15 days. Antiinflammatory and analgesic therapy was prescribed for 4 days [0·1 mg/kg meloxicam (Maxican; Ouro fino) orally every 24 hours and 2 mg/kg tramadol (Dorless; Agener) orally every 12 hours]. The animal was discharged with instructions for strict cage rest for the first 2 weeks postoperatively in order to restrict activity. After that, there was permission for short-assisted walks. Pelvic fractures were not repaired due to the owner’s decision and because it was a young patient without narrowing of the pelvic canal diameter by fracture fragments. After surgery, the patient was evaluated every 3 to 4 months for 1 year. No significant changes were observed in ambulation or in laboratory tests during this period. Urination was normal as reported by the owner. Case 2 A 1-year-old 6-kg male crossbreed dog was presented to the Veterinary Hospital of Franca University (UNIFRAN), Brazil 1 A
day after being hit by a car. Physical examination revealed a red round mass with necrotic areas prolapsed through the anus. The patient also exhibited abdominal sensitivity to palpation. Mild ataxia without signs of urinary obstruction (dysuria) were noted, and urethral catheterisation was easily performed. Complete blood count demonstrated mild leukocytosis with regenerative left shift and biochemical parameters (creatinine, urea, alanine aminotransferase and alkaline phosphatase) were within their respective reference intervals. Radiographs demonstrated fractures of the left ilial body and pubic bone. Prolapse of the urinary bladder through a rupture in the rectum was noted after positive contrast retrograde urethrocystography (Fig 2). While under general anaesthesia with an epidural of 0·22 mg/ kg lidocaine 2%, the bladder was decompressed using a urinary catheter, laparotomy was performed and the bladder was reintroduced through the rectum by the assistant at the same time as the surgeon pulled it into the abdominal cavity through the traumatic laceration of the rectum. The rectal laceration did not appear grossly contaminated and there were no bone fragments adjacent to the lesion. Dorsal partial cystectomy was performed (approximately 70%) due to the extensive bladder necrosis. Following resection, only the bladder trigone region was maintained. The bladder wall was sutured using a Cushing pattern with 4-0 polygalactin 910 and the rectal laceration was sutured using a single, full-thickness layer with a simple interrupted pattern B
FIG. 2. (A) Radiograph showing fracture of the body of the left ilium. The caudal fragment was displaced caudally, and the pubic fracture was aligned. The bladder cannot be identified in its usual anatomic position. In (B) the prolapsed bladder can be evidenced through positive contrast retrograde urethrocystography
2
Journal of Small Animal Practice © 2014 British Small Animal Veterinary Association
Transrectal bladder prolapse in dogs
with 4-0 nylon. Suture bites were spaced 2 to 3 mm from the incision edges and 3 mm apart. Serosal patch reinforcement was used to prevent postoperative leakage. After suturing of the bladder, a leak test was performed before omentalisation. Pelvic asymmetry and/or crepitus was absent on digital rectal examination. Pelvic fractures were not repaired due to the owner’s decision and because it was a young patient. Immediately after surgery, analgesia was provided with 0·3 mg/kg morphine sc (as required), and the patient was treated with antibiotics [22 mg/kg ampicillin (Ampicilina Sódica; EMS) intravenously (iv) and 15 mg/kg metronidazole (Flagyl) iv, both every 12 hours), and topical spray of rifamycin (Rifocina spray; Sanofi Aventis) on the surgical coeliotomy skin wound during the entire period of hospitalisation. A dose of 2 mg/kg tramadol (Tramal injetável; Pfizer) iv and 2·2 mg/kg carprofen (Rimadyl; Pfizer) sc were given every 12 hours for 6 days. The animal remained hospitalised for 15 days. The polyvinyl chloride urethral catheter was replaced every 3 days for 9 days post-operatively using a closed aseptic collection system to avoid contamination. After the hospitalisation period, the animal was discharged with instructions for strict cage rest and short-assisted walks. The patient was reassessed 30 days after surgery and demonstrated normal ambulation with no abnormalities in haematology and biochemistry laboratory tests. Forty-five days after surgery the patient was hit by a car again and died.
in closer proximity to the pubis when compared to females, in which the uterus or uterine stump may act as an anatomical barrier to injury. However, it could be a coincidence, as no other cases have been reported, even in spayed females. Continuous exposure of the mucosa can cause bruises, bleeding, dryness and even necrosis (Sontas et al. 2010). This led to performing an immediate surgery in case 2 as a therapeutic measure. Despite the extensive bladder area removed, the patient did not show signs of lower urinary tract disease following recovery. Mild leukocytosis was the only laboratory abnormality seen in the second case, which may have been due to the longer time of exposure of the bladder to the environment. The absence of postrenal azotaemia from obstruction can be explained by the short time elapsed between trauma and surgical correction of the bladder prolapse, or alternatively could also be explained by partial/incomplete functional obstruction. Surgical intervention by exploratory laparotomy and traction of the bladder through the traumatic rectal laceration allowed the replacement of the organ to its normal anatomical position as well as the surgical repair of the rectum. In combination, these interventions yielded resolution of the clinical signs in both cases. Given the findings in these two cases, the authors propose that rapid diagnosis and early surgical intervention may prevent the need for partial removal of the bladder, which can be a complicating factor for the patient’s prognosis. Despite this, partial cystectomy was required in case 2 and did not affect the shortterm outcome.
DISCUSSION
Acknowledgements We thank Adriana E. W. Burton Meirelles and Adam J Rudinsky for reviewing English text.
There are many factors that contribute to bladder prolapse, including increased abdominal pressure (Mcnamara 1997, Toniollo et al. 2004, Hayes 2004, Prassinos et al. 2010). However, only sporadic reports of trauma resulting in a change in the urinary bladder’s anatomical position have been published. Specifically, a gunshot injury which caused a perineal tear with laceration and exteriorisation of the vagina, and retroflexion of the bladder, was to date the closest description to the cases reported here (Arbeiter & Bucher 1994). Despite no similar case having been reported in dogs, prolapse of the urinary bladder into the space between the vagina and pelvic wall during the last stage of gestation or after parturition occasionally occurs in sows (Heinritzi & Hammerl 1987, Schulz & Bostedt 1995). As a treatment option, the bladder can be repositioned after it is emptied, and a balloon catheter can be used to prevent relapse (Heinnritzi & Hammerl 1987). The same idea was used in the cases presented here and urethral catheter maintenance may have reduced abdominal pain due to distension, and in the second case, may have decreased the risk of leakage of urine. Pelvic fractures are commonly seen with automobile accidents and can cause lacerations to internal organs (Wendelburg 1998, Roehsig et al. 2008). The authors speculate that the rectal lacerations were due to pubic bone fragments in these two cases, as the rectal tears were located ventrally. It can be speculated that both cases occurred in males because the bladder and rectum are Journal of Small Animal Practice © 2014 British Small Animal Veterinary Association
Conflict of interest None of the authors of this article has a financial or personal relationship with other people or organisations that could inappropriately influence or bias the content of the paper. References Arbeiter, K. & Bucher, A. (1994) Traumatically caused prolapse of the vaginal mucosa and retroflexion of the bladder in the bitch. Tierärztliche Praxis 22(1), 78-79 Brissot, H. N., Dupré, G. P. & Bouvy, B. M. (2004) Use of laparotomy in a staged approach for resolution of bilateral or complicated perineal hérnia in 41 dogs. Journal of Veterinary Surgery 33, 495-502 Hayes, G. (2004) Asymptomatic uterine rupture in a bitch. The Veterinary Record 154, 438-439 Heinritzi, K. & Hammerl, J. (1987) Urinary bladder displacement (lateroflexio vesicae urinariae) in the sow. Tierärztliche Praxis 15(2), 145-147. Mcnamara, P. S., Harvey, H. J. & Dykes, N. J. (1997) Chronic vaginocervical prolapse with visceral incarceration in a dog. Journal of the American Animal Hospital Association 33(6), 533-536 Niles, J. D. & Williams, J. M. (1999) Perineal hernia with bladder retroflexion in a female cocker spaniel. The Journal of Small Animal Practice 40(2), 92-94 Prassinos, N. N., Adamama-Moraitou, K. K., Ververidis, H. N., et al. (2010) Vaginal rupture and evisceration in a dog. Acta Veterinaria Hungarica 58(3), 309-315 Schulz, S. & Bostedt, H. (1995) Vesical flexion and vaginal prolapse of sows as an obstetrical problem. Tierärztliche Praxis 23(2), 139-147 Sontas, H. B., Ekici, H., Romagnoli, S. (2010) Canine vaginal fold prolapse: a comprehensive literature review. The European Journal of Companion Animal Practice 20(2), 127-135 Toniollo, G. H., Barbanti, J. M., Delfini, D. A., et al. (2004) Bladder retroflexion. A case report in Blastocerus dichotomus (Cervo-do-Pantanal). The Brazilian Journal of Veterinary Research and Animal Science 41, 137-139 White, R. A. S. & Herrtage, M. E. (1986) Bladder retroflexion in the dog. The Journal of Small Animal Practice 27(11), 735-746
3
CASE REPORT
Transrectal bladder prolapse secondary to pelvic fracture in two dogs L. Z. Crivellenti*,†, M. P. Silveira†, A. N. Silva†, S. Borin-Crivellenti*, T. M. M. Raposo* and D. K. Honsho† *Department of Veterinary Clinical and Surgery, Universidade Estadual Paulista (UNESP), Jaboticabal, São Paulo CEP 14884-900, Brazil †Department of Veterinary Clinical and Surgery, Franca University, Franca, São Paulo CEP 14404-600, Brazil
This report describes the exteriorisation of the urinary bladder in two dogs as a result of a laceration of the rectum from a traumatic pelvic fracture. Clinical examination and contrast radiography of the bladder were used as diagnostic tools. Both patients were treated with exploratory laparotomy, where traction of the bladder was utilised to pull the bladder through the traumatic rectal laceration allowing the organ to return to its normal anatomical position. This procedure was followed by surgical reconstruction of the rectum, resulting in effective resolution of each case. Journal of Small Animal Practice (2014) DOI: 10.1111/jsap.12212 Accepted: 21 February 2014
INTRODUCTION In dogs, acquired changes in the urinary bladder’s anatomical position are uncommon (Arbeiter & Bucher 1994). It has been most commonly described associated with two major conditions: perineal hernia in geriatric dogs due to weakness and separation of pelvic diaphragm components (White & Herrtage 1986, Niles & Williams 1999, Brissot et al. 2004), and increased intra-abdominal pressure during parturition in females, which culminates in vesical prolapse due to excessive straining or following trauma to the vagina (Mcnamara 1997, Toniollo et al. 2004, Hayes 2004, Prassinos et al. 2010). In both conditions, displacement of other abdominal organs, including the small intestines and uterine body, has been reported (Mcnamara 1997, Prassinos et al. 2010). Exteriorisation of the urinary bladder is most commonly described in pregnant sows and deer (Toniollo et al. 2004). In these species, it is generally associated with rupture of the perineal wall between the vulva and the anus (Heinritzi & Hammerl 1987, Schulz & Bostedt 1995). To the author’s knowledge, reports of bladder prolapse with exteriorisation of the urinary bladder in dogs have not yet been described in the veterinary literature. This report describes two cases of prolapse of the urinary bladder in the dog secondary to rectal laceration after motor vehicle trauma.
CASE HISTORIES Case 1 A three-month-old male dachshund dog was presented to the Veterinary Hospital of Franca University (UNIFRAN), Brazil 10 hours after being hit by a car. Journal of Small Animal Practice © 2014 British Small Animal Veterinary Association
Physical examination revealed reluctance to walk on the hindlimbs (but without loss of voluntary movements and nociception). Blunt injury to the inguinal region, marked abdominal sensitivity at the hypogastric area with mild oedema, and externalisation of a thin-walled, fluid-filled sac through the anus, which grossly resembled the urinary bladder (Fig 1A) were also present. Survey radiographs and positive contrast retrograde urethrocystogram revealed displacement of the urinary bladder from its usual anatomic position to the perineal region, passing through the caudal portion of the rectum. Bilateral fractures of the body of the ilium and of the pubic bone, and left sacroiliac joint were noted (Fig 1B). Urethral catheterisation was easily performed and renal values (creatinine and urea) were within their respective reference intervals. Therefore, it was presumed that functional urinary tract obstruction was not present. While under general anaesthesia with an epidural of 0·22 mg/ kg lidocaine 2%, the bladder was decompressed with a urinary catheter and the patient underwent exploratory laparotomy with reintroduction of the urinary bladder into its usual anatomical position. This was performed by passing the urinary bladder back through the opening of the rectum caused by the traumatic laceration. Gross faecal contamination was not noted. The bladder appeared grossly viable and was easy to reduce without the need to expand the rectal tear. The rectal laceration was sutured using a single, full-thickness layer with a simple interrupted pattern with 4-0 nylon suture. Suture bites were spaced 2 to 3 mm from the incision edges and 3 mm apart. Serosal patch reinforcement was used to prevent postoperative leakage. Following this procedure, the abdominal cavity was lavaged with saline solution and the abdomen was closed in a routine fashion. 1
L. Z. Crivellenti et al.
A
B
FIG 1. (A) Externalisation through the anus of a fluid-filled thin sac, which grossly resembled the urinary bladder. The bladder cannot be identified in its usual anatomic position. In (B) the prolapsed bladder can be evidenced through positive contrast retrograde urethrocystography. Aligned fractures were observed in the body of ilium (bilateral) and pubis. Left sacroiliac luxation was also observed
During the postoperative period, analgesia was provided with 0·3 mg/kg morphine subcutaneously (sc; as needed) and the patient was maintained with a polyvinyl chloride urethral catheter for 3 days to maintain an empty bladder and avoid distension or pain. The patient was able to urinate normally after catheter removal. Defaecation was normal two days after surgery. A dose of 30 mg/kg cephalexin (Cefalexina; Neo Química) orally every 12 hours and 10 mg/kg metronidazole (Flagyl; Sanofi Aventis) orally every 12 hours were prescribed for 15 days. Antiinflammatory and analgesic therapy was prescribed for 4 days [0·1 mg/kg meloxicam (Maxican; Ouro fino) orally every 24 hours and 2 mg/kg tramadol (Dorless; Agener) orally every 12 hours]. The animal was discharged with instructions for strict cage rest for the first 2 weeks postoperatively in order to restrict activity. After that, there was permission for short-assisted walks. Pelvic fractures were not repaired due to the owner’s decision and because it was a young patient without narrowing of the pelvic canal diameter by fracture fragments. After surgery, the patient was evaluated every 3 to 4 months for 1 year. No significant changes were observed in ambulation or in laboratory tests during this period. Urination was normal as reported by the owner. Case 2 A 1-year-old 6-kg male crossbreed dog was presented to the Veterinary Hospital of Franca University (UNIFRAN), Brazil 1 A
day after being hit by a car. Physical examination revealed a red round mass with necrotic areas prolapsed through the anus. The patient also exhibited abdominal sensitivity to palpation. Mild ataxia without signs of urinary obstruction (dysuria) were noted, and urethral catheterisation was easily performed. Complete blood count demonstrated mild leukocytosis with regenerative left shift and biochemical parameters (creatinine, urea, alanine aminotransferase and alkaline phosphatase) were within their respective reference intervals. Radiographs demonstrated fractures of the left ilial body and pubic bone. Prolapse of the urinary bladder through a rupture in the rectum was noted after positive contrast retrograde urethrocystography (Fig 2). While under general anaesthesia with an epidural of 0·22 mg/ kg lidocaine 2%, the bladder was decompressed using a urinary catheter, laparotomy was performed and the bladder was reintroduced through the rectum by the assistant at the same time as the surgeon pulled it into the abdominal cavity through the traumatic laceration of the rectum. The rectal laceration did not appear grossly contaminated and there were no bone fragments adjacent to the lesion. Dorsal partial cystectomy was performed (approximately 70%) due to the extensive bladder necrosis. Following resection, only the bladder trigone region was maintained. The bladder wall was sutured using a Cushing pattern with 4-0 polygalactin 910 and the rectal laceration was sutured using a single, full-thickness layer with a simple interrupted pattern B
FIG. 2. (A) Radiograph showing fracture of the body of the left ilium. The caudal fragment was displaced caudally, and the pubic fracture was aligned. The bladder cannot be identified in its usual anatomic position. In (B) the prolapsed bladder can be evidenced through positive contrast retrograde urethrocystography
2
Journal of Small Animal Practice © 2014 British Small Animal Veterinary Association
Transrectal bladder prolapse in dogs
with 4-0 nylon. Suture bites were spaced 2 to 3 mm from the incision edges and 3 mm apart. Serosal patch reinforcement was used to prevent postoperative leakage. After suturing of the bladder, a leak test was performed before omentalisation. Pelvic asymmetry and/or crepitus was absent on digital rectal examination. Pelvic fractures were not repaired due to the owner’s decision and because it was a young patient. Immediately after surgery, analgesia was provided with 0·3 mg/kg morphine sc (as required), and the patient was treated with antibiotics [22 mg/kg ampicillin (Ampicilina Sódica; EMS) intravenously (iv) and 15 mg/kg metronidazole (Flagyl) iv, both every 12 hours), and topical spray of rifamycin (Rifocina spray; Sanofi Aventis) on the surgical coeliotomy skin wound during the entire period of hospitalisation. A dose of 2 mg/kg tramadol (Tramal injetável; Pfizer) iv and 2·2 mg/kg carprofen (Rimadyl; Pfizer) sc were given every 12 hours for 6 days. The animal remained hospitalised for 15 days. The polyvinyl chloride urethral catheter was replaced every 3 days for 9 days post-operatively using a closed aseptic collection system to avoid contamination. After the hospitalisation period, the animal was discharged with instructions for strict cage rest and short-assisted walks. The patient was reassessed 30 days after surgery and demonstrated normal ambulation with no abnormalities in haematology and biochemistry laboratory tests. Forty-five days after surgery the patient was hit by a car again and died.
in closer proximity to the pubis when compared to females, in which the uterus or uterine stump may act as an anatomical barrier to injury. However, it could be a coincidence, as no other cases have been reported, even in spayed females. Continuous exposure of the mucosa can cause bruises, bleeding, dryness and even necrosis (Sontas et al. 2010). This led to performing an immediate surgery in case 2 as a therapeutic measure. Despite the extensive bladder area removed, the patient did not show signs of lower urinary tract disease following recovery. Mild leukocytosis was the only laboratory abnormality seen in the second case, which may have been due to the longer time of exposure of the bladder to the environment. The absence of postrenal azotaemia from obstruction can be explained by the short time elapsed between trauma and surgical correction of the bladder prolapse, or alternatively could also be explained by partial/incomplete functional obstruction. Surgical intervention by exploratory laparotomy and traction of the bladder through the traumatic rectal laceration allowed the replacement of the organ to its normal anatomical position as well as the surgical repair of the rectum. In combination, these interventions yielded resolution of the clinical signs in both cases. Given the findings in these two cases, the authors propose that rapid diagnosis and early surgical intervention may prevent the need for partial removal of the bladder, which can be a complicating factor for the patient’s prognosis. Despite this, partial cystectomy was required in case 2 and did not affect the shortterm outcome.
DISCUSSION
Acknowledgements We thank Adriana E. W. Burton Meirelles and Adam J Rudinsky for reviewing English text.
There are many factors that contribute to bladder prolapse, including increased abdominal pressure (Mcnamara 1997, Toniollo et al. 2004, Hayes 2004, Prassinos et al. 2010). However, only sporadic reports of trauma resulting in a change in the urinary bladder’s anatomical position have been published. Specifically, a gunshot injury which caused a perineal tear with laceration and exteriorisation of the vagina, and retroflexion of the bladder, was to date the closest description to the cases reported here (Arbeiter & Bucher 1994). Despite no similar case having been reported in dogs, prolapse of the urinary bladder into the space between the vagina and pelvic wall during the last stage of gestation or after parturition occasionally occurs in sows (Heinritzi & Hammerl 1987, Schulz & Bostedt 1995). As a treatment option, the bladder can be repositioned after it is emptied, and a balloon catheter can be used to prevent relapse (Heinnritzi & Hammerl 1987). The same idea was used in the cases presented here and urethral catheter maintenance may have reduced abdominal pain due to distension, and in the second case, may have decreased the risk of leakage of urine. Pelvic fractures are commonly seen with automobile accidents and can cause lacerations to internal organs (Wendelburg 1998, Roehsig et al. 2008). The authors speculate that the rectal lacerations were due to pubic bone fragments in these two cases, as the rectal tears were located ventrally. It can be speculated that both cases occurred in males because the bladder and rectum are Journal of Small Animal Practice © 2014 British Small Animal Veterinary Association
Conflict of interest None of the authors of this article has a financial or personal relationship with other people or organisations that could inappropriately influence or bias the content of the paper. References Arbeiter, K. & Bucher, A. (1994) Traumatically caused prolapse of the vaginal mucosa and retroflexion of the bladder in the bitch. Tierärztliche Praxis 22(1), 78-79 Brissot, H. N., Dupré, G. P. & Bouvy, B. M. (2004) Use of laparotomy in a staged approach for resolution of bilateral or complicated perineal hérnia in 41 dogs. Journal of Veterinary Surgery 33, 495-502 Hayes, G. (2004) Asymptomatic uterine rupture in a bitch. The Veterinary Record 154, 438-439 Heinritzi, K. & Hammerl, J. (1987) Urinary bladder displacement (lateroflexio vesicae urinariae) in the sow. Tierärztliche Praxis 15(2), 145-147. Mcnamara, P. S., Harvey, H. J. & Dykes, N. J. (1997) Chronic vaginocervical prolapse with visceral incarceration in a dog. Journal of the American Animal Hospital Association 33(6), 533-536 Niles, J. D. & Williams, J. M. (1999) Perineal hernia with bladder retroflexion in a female cocker spaniel. The Journal of Small Animal Practice 40(2), 92-94 Prassinos, N. N., Adamama-Moraitou, K. K., Ververidis, H. N., et al. (2010) Vaginal rupture and evisceration in a dog. Acta Veterinaria Hungarica 58(3), 309-315 Schulz, S. & Bostedt, H. (1995) Vesical flexion and vaginal prolapse of sows as an obstetrical problem. Tierärztliche Praxis 23(2), 139-147 Sontas, H. B., Ekici, H., Romagnoli, S. (2010) Canine vaginal fold prolapse: a comprehensive literature review. The European Journal of Companion Animal Practice 20(2), 127-135 Toniollo, G. H., Barbanti, J. M., Delfini, D. A., et al. (2004) Bladder retroflexion. A case report in Blastocerus dichotomus (Cervo-do-Pantanal). The Brazilian Journal of Veterinary Research and Animal Science 41, 137-139 White, R. A. S. & Herrtage, M. E. (1986) Bladder retroflexion in the dog. The Journal of Small Animal Practice 27(11), 735-746
3
