Imperforate anus

[Debbie-Spain]

Am trying to "get custody" of a 1-month old poodle with imperforate anus. She basically has no tail at all (not even any sign of one) and no anus. Her poop is evacuated via the vulva. She is still with her mother at the moment. The breeder already gave the order to have her PTS, I am trying to get him to change his mind and give her to us, but it may be a lost cause.

I can't find much information about it in terms of what the operation may involve. It is the first case my local vet has seen where there is no anus at all. I have seen that there have been successful operations (in the US, not sure in Spain) but would be interested to know if anyone has had any experience with this and the outcome of surgery.

She is terribly cute and at the moment as playful as her littermates (she is slightly smaller than the other three pups and apparently was born first). She squats to poop so she obviously has sensitivity and knows when she needs to go. Then her mother comes along and cleans her up.

They are just starting to be given some solid food and I know that may complicate things for her.

I have a sinking feeling he's not going to give her to us... some breeders here will refuse to do anything except sell a pup. Once we offered to take a great dane pup that was deaf and the breeder preferred to have him PTS...

Still, if anyone has any info it would be very useful,

Thanks

Debbie

[CarolC]

No experience but I found a nice article.

http://www.pubmedcentral.nih.gov/articl ... id=1914316

P.S. I looked up "atresia" in Taber's:

[" + tresis, a perforation] Congenital absence or closure of a normal body opening or tubular structure.

anal a. Imperforate anus

http://www.cliniciansbrief.com/uploads/ ... _cap11.pdf

http://74.125.95.113/search?q=cache:Os0 ... =clnk&cd=1 (still looking, this is in Spanish)

http://www.vet.unne.edu.ar/revista/19-1 ... %5D....pdf

http://veterinaria1994.blogspot.com/200 ... es-de.html (graphic)

http://www.veterinaria.uach.cl/noticia.php?codigo=746 (another poodle)

[Debbie-Spain]

Thanks Carol, I had found the abstract to that first article and was translating it for my vet, but not the whole thing, will have a look later and at the other links too. What I had already seen from the abstract was that it seemed that the poodle cases in it were similar to her case.

It was a holiday here today so I won't know anything until tomorrow or possibly even Monday. My main worry is that she will start to get sick and they won't do anything until it is too late...

Thanks again,

Debbie

[Debbie-Spain]

Just got the message to go and pick her up this evening! Spoke with one of the surgeons at the vet hospital here, they have never had a case in dogs but have operated on kittens and will be happy to take a look at her...

At least she is going to get a chance, thanks Carol for the info, it was a great help...!

Will post pics when I can, she is really cute...

Debbie

[Debbie-Spain]

1st pic, I spoke to the nearest veterinary hospital that I usually go to with complicated cases. They only ever operated for this in a litter of kittens but are willing to take a look, so we should hopefully be going tomorrow... she is sweet and playful but spends a lot of time crouching to try and poop...

Debbie

[Friend2Dogs]

She is adorable!!!!!

[Debbie-Spain]

She is now called Brisa. Amazingly, the tests she has had done at the hospital (contrast x-rays, scans and endoscopy, etc.) appear to show that there is no fistula. In other words, it seems she has never pooped at all. Yet she is still lively and playful. It appears that the intestine just ends in a blind wall. If we are lucky they can make a hole to serve as an anus and make the connection directly from there. If we are unlucky, they will have to open from the belly area and go through the pelvis to join everything up. The main worry in that case is the lengthening of the operation time and her exposure to the anasthetic and it will be more traumatic. They may also have to open up the intestine in order to empty it out, which again, opens up the potential for complications.

It is a virtual certainty that even if the operation is a success she will have fecal incontinence, and we will have to see whether she will suffer from megacolon which is a major possibility. But there is no alternative except to have her PTS. And even the hospital staff are amazed at how happy and resilient she seems to be, so hopefully she can stand up to the operation. If we leave it any longer she may start getting ill, so despite being worred about her being strong enough to stand up to the anaesthetic, we are forced to go ahead, it'sher only chance. The operation will be tomorrow or the day after, depending on how long she takes to recover from the anaesthetic she had today for the tests...

Hope people can send her positive vibes! I am really willing her to come through, firstly because she is so happy and playful and strong that she deserves to live, and secondly, because it's so important here that people here in Spain see that there are alternatives to PTS-ing every time there is a problem. The pic is of her in the hospital, she has been there since last Thursday...

Debbie

[CarolC]

Best wishes for sure. I don't see how she could reach this age and size without ever eliminating.

Have you seen pouchpanties? They are custom made diaper covers with extra fullness to catch incontinence.

www.pouchpanties.com

Sam's Dog Hut sells a diaper cover with a cord-lock tail.

http://www.samsdoghut.com/catalog_g3.html?catId=56269

Will be waiting to see how she does, I really hope this works out.

[GabrielDeafBlindPupFamily]

My son was born with an incomplete urinary system. No way for urine to escape. The dangers of urine back up, toxemia, the tests, the possible solutions, I could not being to describe. Same thing with you. It has to escape. Whether up the throat (which killed my AllixMurderedPup, she asphyxiated on feces after being shot in the spine) or like Andy found another way to evacuate. In Andy's case, we took weekly tests until he was old enough (13 months) to tolerate surgery. They built a urinary system. Built a urethra. He developed a fistula at 3 years and we had to FIND that sucker (I won't even go in to that, trying to find it!) but when it was found, a new surgery built a new urinary system. He then had to have tests and they were pretty rough for a baby. A router (yes, a stinkin router) was used to clean out the system and Andy's screams could be heard two stories up and two stories down. I had to stand down and my husband laid himself over Andy for everything awful.
The evacuation is key and it can be tested. I KNOW that testing has improved over the last 25 years, and always insist on pain meds for testing. There is an evacuation point somewhere and if it is internal, puppers needs some help and needs it now. Pupis BEAUTIFUL!

[Debbie-Spain]

Thanks both. Karen that must have been very tough...

I know it's kind of impossible that she isn't eliminating, it's a puzzle, that's why I say she's like a little miracle, but I never saw her poop and at the hospital she hasn't pooped either. On her x-rays you can see that she is backed up with poop all the way round her rib cage, the only places not full of poop are full of gas. Until a week ago she was with her mother and on milk, she really only had solid foods for a couple of days, apparently within the context of it being quite a rare problem, this is the usual time of presentation, when they move onto solid foods. I suppose there would be a possibility of a fistula somewhere higher up than the bladder but they couldn't find one, the contrast fluid obviously couldn't do the full run of her digestive system. Or maybe she had a fistula that has closed or got blocked somehow? Not really sure if that is a possibility. But the only thing that is coming out of her at the moment is urine. She has never even vomited. That's why we have to go ahead and operate now, she has to be emptied. I couldn't find a vet here who had ever operated on a dog with imperforate anus. The surgeon who will operate has operated on kittens with the same problem however, that was the best I could find. It's not an easy decision to make, but it's her only hope...

I have seen a few case reports where the megacolon resolved after the operation. I have given up on the hope of her not having fecal incontinence, but if we can get away without the megacolon that would be a good thing...

She's so tiny and happy and fragile, I can't believe how worried I am for her when I only had her with me for a day...

Thanks for your interest and helpful advice, as always!

Debbie

[nez]

She is so precious,praying the operations is a success,thank you for saven her,she is beautiful,,,, nez

[Debbie-Spain]

Brisa was operated on yesterday and she made it through the operation okay, although it's a bit soon yet to gauge the results.

The surgeons found a "point" right above the vulva that they felt might have been where the anus was going to develop, so instead of going in at the point where it would normally be (higher up), they went in at that point. Their hunch turned out to be correct, they didn't have to travel far to find the rectum and attach it to the orifice they made. The good news is that there may even be a bit of functional sphincter there, it would be excellent if she managed to gain control in the longer term. The not-so-good news is that the new anus is in the wrong place, i..e right above the vulva, so the wall of the vagina and that of the rectum are right against each other. That will mean that there will be a fairly constant problem with infections, especially if she has fecal incontinence.

But the idea is to leave things like that for the moment, see whether the whole thing works (she did a tiny amount of poop after the op but there is a lot of stuff waiting to come out which may need some help; the entire intestine is very distended so it remains to be seen whether the colon will recover motility). When she is a little older, if there is a problem with infections, the idea is to operate again, and move the anus to its proper place.

I feel that the surgeons did the right thing, I was very worried that she wasn't going to hold out with the anaesthetic because of her being so young. I don't know whether this operation has been done before in Spain, we certainly haven't been able to find any reports on it, so I am very very pleased.

She will remain in hospital a few days for them to observe how things progress. There is a lot of potential for complications. But at the moment at least I feel she is in with a fighting chance now...

Thanks for your interest and support, will update when I have more news...

Debbie

[GabrielDeafBlindPupFamily]

Debbie-Spain we are all holding our collective breaths! Hugs to your little baby! Let us know ...

[CarolC]

Debbie that is wonderful! I am so glad! It doesn't seem like there would be a problem with outside contamination unless she has diarrhea...? Wouldn't the angle of a squat mean the trajectory would miss the female area? Is it like 1/4" apart and the female sticks out farther than the new anus so she can't miss ? It seems like there would be a possible problem with yeast infections if the wall of the vagina is thin and so close to the rectum. This is one time I'd consider acidophilus. That is very cool about a possible sphincter, maybe it will develop further musculature and bulk out a little? Can't wait to hear how she does.

[Debbie-Spain]

Thanks Carol, I was just coming to give the latest update from the hospital which is that she has started to poop with the help of massages. There is still a lot to come out, but it does seem to be starting to work. They are sure she will need the further surgery because the two are really too close. But more good news is that she is lively and eating. And finally, that I have to call early tomorrow evening (about 5 p.m.) to see if I can go and collect her and bring her home for the weekend. So things look promising.

I can't really answer your questions until I see her tomorrow (the hospital is too far for me to visit every day). Before her op she would squat and of course, nothing would happen, I don't know if she will squat now, but if she does (and I think she might) you could well be right. The surgeon seemed to be more worried about the internal walls being close to each other, I'm not sure what the risk of cross-contamination is there.

We will have to see. We also have a person with excellent references possibly interested in adopting her, which would be very good news!

At the moment I'm just hoping she gets through another night okay and gradually gets her strength back. I feel so proud of her for being such a little fighter. You know, sometimes here you get the feeling that everyone thinks you are pushing for something that is impossible and that it's not worth the effort, so when they pull through it is such a relief and a joy.

Will keep on updating, hopefully in about 30 hours she could be here with me... not that she will be better here than in hospital but it means that they are pleased with her progress. Great, another new "dog with fecal problems" in the house just in time for my parents arriving from the UK next week to visit

Thanks for being there...

Debbie