The Abdomen 299 



It has been suggested that in the scrotal and perineal forms 

 celiotomy should be performed, the herniated portion withdrawn 

 through the ring and then stitched to the abdominal wall to prevent 

 its return to the sac. This would surely be an error for the very 

 simple reason that the ring and sac would still persist, and there 

 would be no provision to prevent the escape of some other portion 

 of the bowel or other organ. 



Perineal Hernia. The fold of peritoneum which in males is 

 reflected from the bladder to the rectum on either side, gives rise 

 in the center to a prolongation of the peritoneal cavity— the fossa 

 or cul-de-sac of Douglas, or excavatio recto-vesicalis. In females 

 two such prolongations are formed, one between the uterus and 

 rectum — the excavatio vesico-uterina. Perineal hernia constitutes 

 the passage into one of these cul-de-sacs of a portion of the bowel, 

 the omentum, the uterus, the bladder, or enlarged prostate. The 

 lesion is observed quite frequently in old males, and it is said, par- 

 ticularly in performing animals which are taught to walk on their 

 hind legs. It is otherwise usually produced as a result of expulsile 

 efforts necessitated by the presence of hypertrophied prostrate. It 

 can exist for a long time without interfering with the animal's 

 health. It seldom becomes strangulated, though torsion of the 

 bladder is apt to take place, when that organ forms the contents, 

 or even a fistula may form. Lienaux has recorded witnessing a 

 displaced rectum caused by an enlarged prostate. 



Symptoms and Diagnosis. This form of hernia appears in the 

 male as a subcutaneous swelling between the root of the tail and 

 the ischial tuberosity. In the female the swelling occurs in the 

 region of the vulva. Lucet saw a double perineal hernia, the swell- 

 ing on the right side being formed by the bladder, that on the 

 left by a portion of the omentum. In Lienaux's case, above referred 

 to, the swelling appeared beneath the anus. 



When the contents consist of the bladder the tumor has a soft 

 elastic consistence, resembling a cyst. In this case there is usually 

 dysuria. To determine the condition with accuracy the aspirator 

 should be employed. A large perineal hernia may interfere with 

 defecation and force the anus out of its natural position to one side. 

 It may be mistaken for enlarged anal pouches, from, which it must 

 be carefully differentiated. 



Treatment. If dysuria is present the bladder must be replaced 



