Diagnosis of perineal hernia by ultrasonography and its surgical correction in a crossbred cow

Introduction

A perineal hernia is characterized by the protrusion of abdominal or pelvic organs through a defect in the pelvic diaphragm, the muscular structure responsible for supporting the rectal wall (Ferreira and Delgado, 2003) [1] . Although the exact cause of weakening of these muscles is not clearly established, several factors have been proposed, including age-related or neurogenic muscle atrophy, primary muscle disorders, and endocrine or hormonal influences (Hedlund, 2002) [4] . Perineal herniation is considered uncommon in ruminant species, particularly in cattle and buffalo. When reported in ruminants, the condition is observed more frequently in females (Prasad et al., 2015; Vadalia et al., 2017) [8,14] . In most cases, perineal hernias are identified either during the early stages of pregnancy or in the period shortly following parturition (Singh et al., 2017) [13] . Perineal hernia is very common in small animals and uncastrated male dogs (Kumar et al., 2016) [6] . Earlier reports suggested that persistent tenesmus and chronic diarrhea may contribute to weakening of the pelvic diaphragm, and that subsequent trauma can lead to herniation of pelvic viscera such as the urinary bladder and loops of the large intestine (Prasad et al., 2015) [8] . In cases where the urinary bladder becomes entrapped within the hernial sac, affected animals may exhibit clinical signs including stranguria and tenesmus (Singh et al., 2017; Gill and Barstad, 2018; Kumar et al., 2021) [13,2,6] , although normal defecation has also been reported in some instances (Priyanka et al., 2018) [9] . Ultrasonographic examination typically demonstrates a hyperechoic hernial sac containing hypoechoic, homogeneous hernial contents (Kumar et al., 2021) [6] . Surgical correction of perineal hernia (herniorrhaphy) is most commonly performed with the animal in a standing position (Kumar et al., 2021) [6] , whereas procedures conducted in sternal recumbency have been reported only rarely (Prasad et al., 2015 [8] Various surgical techniques have been described for the correction of perineal hernia. These include direct ventral suturing between the external anal sphincter and the internal obturator muscle, as well as herniorrhaphy involving suture placement between the external anal sphincter and the levator ani, coccygeus, or both muscles (Priyanka et al., 2018; Gosai et al., 2019) [9,3] . In cases of large perineal hernias in cattle and buffalo, successful repair has also been achieved through hernioplasty using synthetic mesh, which facilitates tension-free closure of the hernial defect (Malik et al., 2012) [7] . Following surgical repair of a perineal hernia, several postoperative complications may occur. Commonly reported problems include wound infection, wound dehiscence, persistent clinical signs such as fecal incontinence and tenesmus, rectal prolapse, urinary tract dysfunction, sciatic nerve paralysis, and recurrence of the hernia, particularly in dogs (Hedlund, 2012) [5] .

Case summery

Four-year-old crossbred cattle presented to the Department of Veterinary Surgery and Radiology, Hisar, Haryana with a history of soft, fluctuating, non-painful and non-reducible mass hanging on right lateral aspect of vulva (Figure 1a). The animal was normally defecating but stranguria was present in the past 8 days and history of recent parturition. Ultrasonography confirmed a unilateral perineal hernia containing the urinary bladder (Figure 1b). On the basis of history, clinical examination and USG, it was diagnosed as unilateral perineal hernia. Epidural anaesthesia was given with lignocaine hydrochloride 2% w/v (Lox 2%; Neon Laboratories Ltd) @ 0.5 mg/kg body weight. The site was shaved, cleaned aseptically through povidone-iodine scrub (Sistadine surgical scrub-7.5%, Sisla laboratories, Narela Delhi). Percutaneous purse-string nonabsorbable monofilament polyamide black (Trulon ® 2, Helthium Medtech limited, Bangalore, Karnataka) applied on to anus after removal of faeces and placement of foleys (Romson, foley trac ® ) catheter inside urinary bladder. Surgery was performed in standing position. A linear incision of 12 cm was given over perineal swelling (Figure 2a). Urinary bladder as hernial content was identified after proper anatomical dissection. Content was found free from adhesion and repositioned without any difficulty. After reposition hernial ring was appreciated. Hernial ring was 4 fingers wide (Figure 2b) and herniorrhaphy was conducted using simple interrupted pattern with absorbable braided and coated polyglycolic acid (Truglyde ® 2, Helthium Medtech limited, Bangalore, Karnataka). Underlying fascia and muscle were sutured (Figure 2c) with absorbable braided and coated polyglycolic acid (Truglyde ® 2-0, Helthium Medtech limited, Bangalore, Karnataka) and skin was sutured through nonabsorbable monofilament polyamide black (Trulon ® 2, Helthium Medtech limited, Bangalore, Karnataka) and pursestring suture was removed immediately after surgery. Antiseptic dressing was done with povidone-iodine scrub (Sistadine microbicidal solution-10%, Sisla laboratories, Narela Delhi) and triple-antibiotic (neomycin sulphate, polymyxin B sulphate and bacitracin; Aluspray-AWD ® , Vetoquinol). Post-operatively, the cattle were given Penicillin-streptomycin combination (Penstrep) intramuscularly once daily at a dose of 10,000 IU penicillin/kg, 6.2 mg of streptomycin/kg and 6.25 mg of dihydrostreptomycin/kg for five successive days. Phenylbutazone (Phenylbutazone 20% injection) was given intravenously at a dose of 4 mg/kg body weight once daily for three successive days as anti-inflammatory drug. The wound was dressed three times a day with Povidone-iodine antiseptic solution for 10 days. Then, the stitches were removed 10 days post-operatively. The case was followed up for 2 months, the straining during urination disappeared a few days after surgery and uneventful recovery with neither recurrence nor complications was reported.

Discussion

Perineal hernia in large ruminants is reported predominantly in females, likely due to anatomical factors such as wider pelvic musculature, repeated parturition, and increased likelihood of pelvic floor weakening (Prasad et al., 2015) [8] . Singh et al. (2017) [13] and Vadalia et al. (2017) [14] also documented a higher incidence in female cattle compared to males, suggesting a hormonal and reproductive influence in disease predisposition. The present case aligns with this pattern, involving a female patient but did not assess endocrine parameters, and therefore this association remains speculative rather than confirmed. Although defecation remained normal in the present case, the occurrence of stranguria corroborates similar findings documented in buffalo and cattle affected with perineal hernia due to the urinary bladder being included in the hernia (Shridhar 2011; Prasad et al., 2015; Gosai et al., 2019) [11,8,3] . The hernia content of the present case was a urinary bladder. In large animal clinical practice, perineal hernias in buffaloes, cattle, and goats have been reported to contain organs such as the urinary bladder, omentum, intestine, and, in some cases, the pregnant uterus (Shridhar 2011 [11,12,14,9,3] . Diagnosis of perineal hernia in cattle is primarily based on clinical examination and ultrasonography, which remain fast, non-invasive and reliable tools for identifying herniated abdominal organs. In the present case, ultrasonography was instrumental in confirming urinary bladder herniation, consistent with previous reports of similar cases in bovines (Sankar et al., 2025) [10] . Contrast cystography or retrograde contrast techniques have been shown to help differentiate perineal hernia from perineal swelling of other etiologies such as abscess, haematoma, or vaginal prolapse (Sankar et al., 2025) [10] . In this case, contrast imaging was not performed, which may be considered a diagnostic limitation. The successful outcome following suture herniorrhaphy in the present case may be attributed to the size of the hernial ring and adequate tissue integrity. Nevertheless, polypropylene mesh reinforcement has been reported as a useful alternative in buffaloes with larger perineal hernia defects (Malik et al., 2012; Kumar et al., 2021) [7,6] . Although perineal hernia repair in dogs is frequently complicated by wound infection, dehiscence, persistent tenesmus, fecal incontinence, rectal prolapse, urinary dysfunction, sciatic paralysis, and recurrence (Hedlund, 2012) [5] , no such complications were recorded in the present case during the two-month follow-up period.

Conclusion

Perineal hernia in cattle, although rare, should be considered when perineal swelling is associated with urinary difficulty. Early diagnosis and surgical repair remain essential to prevent complications. The successful outcome in this case demonstrates that prompt herniorrhaphy and proper perioperative management can result in a favourable prognosis.

Conflict of Interest

Financial Support

References

1. Ferreira F, Delgado E. Perineal hernias in small animals. Portuguese Journal of Veterinary Sciences. 2003;98(545):3-9.
2. Gill SS, Barstad RD. A review of surgical management of perineal hernia in dogs. Journal of the American Animal Hospital Association. 2018; 54:179-187.
3. Gosai RK, Chauhan PM, Patel KD, Patelia HR. Perineal hernia in a buffalo: a case report. Veterinary Research. 2019;7(1):13-14.
4. Hedlund CS. Perineal hernia. In: Fossum TW, editor. Small animal surgery. 2nd ed. St. Louis: Mosby; 2002. p. 433-437.
5. Hedlund CS. Perineal hernia. In: Fossum TW, editor. Small animal surgery. 4th ed. St. Louis: Mosby; 2012. p. 568-573.
6. Kumar V, Asodiya FA, Vora SD, Singh VK. Perineal hernia repair using polypropylene mesh in three female Jaffarabadi buffaloes: a short communication. Veterinary Archives. 2021;91(3):327-332.
7. Malik V, Purohit S, Panday RP, Singh B. Surgical management of perineal hernia using nylon mesh in a buffalo. Indian Journal of Veterinary Surgery. 2012; 33:71-71.
8. Prasad V, Prasad R, Kamalakar G, Mahesh V. Perineal hernia in a buffalo heifer: a case report. Research and Reviews: Journal of Veterinary Science and Technology. 2015;4(3):22-24.
9. Priyanka, Sharma S, Chaudhary RN, Niwas R, Arora N. Surgical management of perineal hernia in a crossbred cow: a case report. International Journal of Current Microbiology and Applied Sciences. 2018;7(12):385388.
10. Sankar R, Jaianusiya A, Kalaiselvan V, et al. Perineal hernia in a crossbred Jersey cow and its successful surgical management: a case report. Indian Journal of Veterinary and Animal Sciences Research. 2025;54(1):102-105.
11. Shridhar NB. Perineal hernia in a crossbred cow and its surgical management. Indian Journal of Animal Research. 2011;45(1):73-74.
12. Salci SO, Guner B. Perineal hernia containing pregnant uterus in a doe. Thai Journal of Veterinary Medicine. 2016;46(3):503-507.
13. Singh J, Singh S, Bansal P. Surgical correction of perineal hernia in bovines: a clinical study. International Journal of Veterinary Science. 2017;6(2):98-101.
14. Vadalia J, Chaudhary D, Modi L, Patel K. Management of perineal hernia in a cow: a case report. Indian Journal of Veterinary Sciences and Biotechnology. 2017;13(1):85-87.