pISSN 1598-298X J Vet Clin 30(5) : 376-379 (2013) 376 Surgical Correction of Congenital Type III Atresia ani with Rectovaginal Fistula in a Cat Minkyung Kim**, Yong-Hyun Hwang* , **, Woo Choi* and Jae-Hoon Lee** 1 *Pet’s All Animal hospital, Changwon-si 631-712, Korea **Institute of animal medicine, Veterinary Surgery, College of Veterinary Medicine Gyeongsang National University, Jinju 660-701, Korea (Accepted: October 23, 2013) Abstract : A four-week-old female Scottish Fold cat weighting 0.6 kg was admitted for vaccination. During the physical examination, the liquid feces were observed from the vulva and the anus was imperforate. The location of a narrow fistula and distended colon were identified on the contrast radiography. Definitive diagnosis was made as type III atresia ani with rectovaginal fistula. Anal reconstruction and ligation of the fistula were successfully undertaken to treat atresia ani. After surgery, the cat was treated with lactulose and a special diet consisting of high fiber was fed to increase digestibility. The cat was able to control defecation after 2 weeks post-operation. There was no complication for 8 months after surgery. Key words : Atresia ani, rectovaginal fistula, surgical correction, cat. Introduction Atresia ani (AA) is a congenital defect of the anorectum, resulting in anal canal closure and / or abnormal rouging of feces. AA develops during formation of the embryo when normal separation of the primitive cloaca into the rectum and urogenital sinus by the urerectal fold is not completed, and imperforate anus results from failure of anal membrane open- ing after anal development in the fetus (1,12). According to a review in the Veterinary Medical Database, AA accounts for 0.007% of cases in dogs with females more likely to be affected than males (female: male = 1.79: 1) (12). In cats, females are more commonly affected than males (3,9-11). The most common classification of AA similar to that used in humans has been described in dogs and cats (2,4,12). This classification includes four basic anatomical types (2). Type I classification denotes anal stenosis without an imperforate anus. Animals with type II anomalies have a persistence of the anal membrane, and the rectum ends immediately cranial to the imperforate anus as a blind pouch. In type III, the anus is also closed, but the blind end of the rectum is situated far- ther cranially. In type IV, the anus and terminal ends as a blind pouch within the pelvic canal. The prognosis for atresia ani is poor and although surgical correction may be attempted, affected animals are young, small and typically poor in body condition and thus the sur- gical mortality rate is high (2). In this kitten attempts were made to surgically correct the anatomic malformations. The purpose of this report is to describe the clinical signs, radiographic findings, surgical treatment of type III atresia ani in a Scottish Fold cat. Case A four-week-old female Scottish Fold cat weighing 0.6 kg in good clinical condition showing good signs of activity was admitted for vaccination. During the physical examination, abdominal distension was revealed and liquid feces were observed from the vulva and the anus was imperforate (Fig 1). A complete blood count and biochemical panels were within reference ranges, except for mild lymphocytosis. The location of a narrow fistula and distended colon were identified in contrast radiography (Fig 2) using iohexol (Omi- paque, Amersham health, Cork, Ireland). Definitive diagnosis was made as type III atresia ani with ureterorectal fistula. The cat received cefazolin, 30 mg/kg IV (CEFAZOLIN, Chong Hun Dang) and atropine 0.04 mg/kg SC (Jaeil Pha- maco, South Korea) before the induction of anesthesia and was premedicated with medetomidine, 0.02 mg/kg IM (Domi- tor®, Orion PharmaCo., Finland). Anesthesia was induced with propofol, 6 mg/kg (Anepol, Hana Pharm Co., Ltd., Korea), a size 2.5-cuffed endotracheal tube was inserted and 1.5% isoflurane (Forane, Rhodia Organique Fine Ltd., Korea) and oxygen (approximately 1.5 L/min) were added to the room air. The cat was aseptically prepared and placed in ven- tral recumbency with the elevation of the anus and rigid sta- 1 Corresponding author. E-mail : [email protected]
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pISSN 1598-298XJ Vet Clin 30(5) : 376-379 (2013)
376
Surgical Correction of Congenital Type III Atresia ani with
Rectovaginal Fistula in a Cat
Minkyung Kim**, Yong-Hyun Hwang*,**, Woo Choi* and Jae-Hoon Lee**1
*Pet’s All Animal hospital, Changwon-si 631-712, Korea
**Institute of animal medicine, Veterinary Surgery,
College of Veterinary Medicine Gyeongsang National University, Jinju 660-701, Korea
(Accepted: October 23, 2013)
Abstract : A four-week-old female Scottish Fold cat weighting 0.6 kg was admitted for vaccination. During the physicalexamination, the liquid feces were observed from the vulva and the anus was imperforate. The location of a narrowfistula and distended colon were identified on the contrast radiography. Definitive diagnosis was made as type III atresiaani with rectovaginal fistula. Anal reconstruction and ligation of the fistula were successfully undertaken to treat atresiaani. After surgery, the cat was treated with lactulose and a special diet consisting of high fiber was fed to increasedigestibility. The cat was able to control defecation after 2 weeks post-operation. There was no complication for 8months after surgery.
Key words : Atresia ani, rectovaginal fistula, surgical correction, cat.
Introduction
Atresia ani (AA) is a congenital defect of the anorectum,
resulting in anal canal closure and / or abnormal rouging of
feces. AA develops during formation of the embryo when
normal separation of the primitive cloaca into the rectum and
urogenital sinus by the urerectal fold is not completed, and
imperforate anus results from failure of anal membrane open-
ing after anal development in the fetus (1,12). According to a
review in the Veterinary Medical Database, AA accounts for
0.007% of cases in dogs with females more likely to be
affected than males (female: male = 1.79: 1) (12). In cats,
females are more commonly affected than males (3,9-11).
The most common classification of AA similar to that used
in humans has been described in dogs and cats (2,4,12). This
classification includes four basic anatomical types (2). Type I
classification denotes anal stenosis without an imperforate
anus. Animals with type II anomalies have a persistence of
the anal membrane, and the rectum ends immediately cranial
to the imperforate anus as a blind pouch. In type III, the anus
is also closed, but the blind end of the rectum is situated far-
ther cranially. In type IV, the anus and terminal ends as a
blind pouch within the pelvic canal.
The prognosis for atresia ani is poor and although surgical
correction may be attempted, affected animals are young,
small and typically poor in body condition and thus the sur-
gical mortality rate is high (2).
In this kitten attempts were made to surgically correct the
anatomic malformations. The purpose of this report is to
describe the clinical signs, radiographic findings, surgical
treatment of type III atresia ani in a Scottish Fold cat.
Case
A four-week-old female Scottish Fold cat weighing 0.6 kg
in good clinical condition showing good signs of activity was
admitted for vaccination. During the physical examination,
abdominal distension was revealed and liquid feces were
observed from the vulva and the anus was imperforate (Fig
1). A complete blood count and biochemical panels were
within reference ranges, except for mild lymphocytosis.
The location of a narrow fistula and distended colon were
identified in contrast radiography (Fig 2) using iohexol (Omi-