https://doi.org/10.52973/rcfcv-e34338
Received: 14/10/2023 Accepted: 18/01/2024 Published: 01/04/2024
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Revista Científica, FCV-LUZ / Vol. XXXIV, rcfcv-e34338
ABSTRACT
Recto–vaginal fistula (RVF) associated with atresia ani (AA) are
congenital anomalies in which fecal and urinary output occurs through
the vulvar region. In this study, 17 ruminants (lamb n=9, calf n=8)
constituting type II AA–associated RVF cases were included. The cases
were evaluated clinically, radiographically and ultrasonographically.
abdominal distension, partial perineal swelling and hematochezia.
The abdomen and pelvis were evaluated by direct radiography and
gaseous distension, dilated colon, moderate or severe megacolon were
diagnosed. Using radiographic assessment of the distance between
the rectum blind pouch and perineum, AA was typed and all cases
were diagnosed as Type II AA. Ultrasonography was used to classify
All operations were performed by anoplasty using the rectal–pull
through technique. No complications were encountered during the
postoperative follow–up period. The aim of this study was to provide
information about the diagnosis, treatment and use of radiography
and ultrasonography in Type II AA with RVF in lambs and calves.
Key words: ;
ultrasonography
RESUMEN
Las fístulas rectovaginales (FRV) asociadas a atresia anal (AA) son
anomalías congénitas, en la cual, la salida fecal y urinaria se realiza a
través de la región vulvar. En este estudio se incluyeron 17 rumiantes
(cordero n=9, ternero n=8) que presentaban FVR asociada a AA de tipo
Los hallazgos clínicos fueron tenesmo, heces en la zona perivulvar,
distensión abdominal, irritación perineal parcial y hematoquecia. El
abdomen y la pelvis se evaluaron mediante radiografía directa y se
diagnosticó distensión gaseosa, colon dilatado y megacolon moderado
casos se diagnosticaron como AA de tipo II. Se utilizó la ecografía para
los casos evaluados. Todas las intervenciones se realizaron mediante
anoplastia utilizando la técnica de extracción a través del recto. No
se produjeron complicaciones durante el periodo de seguimiento
postoperatorio. El objetivo de este estudio fue aportar información
sobre el diagnóstico, el tratamiento y el uso de la radiografía y la
ecografía en la AA de tipo II con FRV en corderos y terneros.
Palabras clave:
Radiographic, ultrasonographic and surgical treatment of rectovaginal
stula disease associated with atresia ani in ruminants
Tratamiento radiográca, ultrasonográca y quirúrgica de la fístula
rectovaginal asociada a atresia anal en rumiantes
Kerem Yener* , Ali Hayat , Ünal Yavuz , Mehmet Salih Karadağ , Kübra Dikmen , Mehmet Sıdık Hurma
Harran University, Faculty of Veterinary Medicine, Department of Surgery. Şanlıurfa, Türkiye.
*Corresponding author: keremyener@harran.edu.tr
Ruminant Atresia Ani: Diagnosis and Repair of Rectovaginal Fistulas / Yener et al.__________________________________________________
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INTRODUCTION
Congenital anomalies involving the rectum and anus in the
gastrointestinal tract are common in all animal species, with an
approximate incidence of 4.3% [1]. Genetic and environmental factors
are thought to be effective in the etiology of congenital anomalies,
but the exact causes are unknown [1, 2].
Atresia ani (AA) is a congenital anomaly of the rectum and anus
characterized by the inability to pass feces due to the closure of
the anal canal (anus) [3]. In the etiology of AA, teratogens found in
plants and viral diseases during pregnancy have been reported for
cattle, while it has been reported to be the result of an autosomal
recessive gene for sheep [4, 5]. Clinical signs in affected animals
include progressive abdominal distension, tenesmus and prominence
of the anal/perineal region [6]. AA is divided into four classes in all
animals: Type I AA is a congenital stenosis of the anus. In type II
AA, the membrane of the anus persists and the rectum ends as a
blind pouch just cranial to the anus without a hole. In type III, the
anus is closed and the blind end of the rectum is more cranial. In
type IV atresia ani, the anus and terminal rectum develop normally,
but the cranial rectum ends as a blind pouch in the pelvic canal
[7]. Surgical correction is the most indicated treatment for this
disease and therapeutic success has been reported to depend on
the degree of rectal development [6]. Given the importance of this
disease in ruminant species, low therapeutic success has been
reported [3, 6, 8]. AA can be associated with congenital diseases
such as rectovaginal fistula (RVF), rectocystic fistula, vagino–
urethral agenesis, taillessness, hypospadias and diphallus [8]. These
congenital anomalies of the external genital organs are of special
importance due to their repercussions on future generations [5].
RVF is another congenital problem in female ruminants that causes
a direct connection between the rectum and vagina and is responsible
for urofecal mixing, and if the vulva is formed, it serves as a common
opening for both the digestive and urogenital tracts [5, 9]. Studies
have reported that most cases of RVF are associated with type II
AA, and type III AA is encountered in fewer cases [10]. In most of
the affected animals described in the veterinary literature, various
degrees of fecal impaction and colonic distension are evident on
radiographic examination in RVF associated with AA [9]. Common
clinical signs include defecation from the vulva, vulvar irritation,
cystitis most commonly associated with E. coli and Proteus spp. [11].
In the veterinary literature, AA–associated RVF have been reported
in calves (Bos taurus) and lambs (Ovis aries
data, especially radiographic and ultrasonographic evaluations [12].
Anoplasty is the most common surgical procedure performed in RVF
associated with AA. Anoplasty aims to restore anorectal continuity,
preserve the external anal sphincter, restore colonic function and
surgical correction of atresia types I, II and III [6, 11]. When not treated
surgically, animals with atresia ani type II and III have been reported
to have fatal outcomes due to intestinal obstruction [10].
This study aims to contribute to clinician veterinarians by evaluating
AA–related RvF cases observed in calves and sheep.
MATERIALS AND METHODS
A total of 17 female ruminants consisting of lambs (n:9) ( 53%) and
calves (n:8) ( 47%) brought to Harran University, Faculty of Veterinary
Medicine, Animal Hospital, Turkey, with the complaint of fecal and
urinary output from the female genital organs due to absence of
the anus region constituted the material of this study. Species,
age, breed, AA–RVF type, treatment and 6 months postoperative
follow–up information were recorded. RVF disease associated with
AA was evaluated with clinical, radiographic and ultrasonographic
examinations and surgical procedure was decided. The data included
in the study were AA type and RVF localization, surgical procedure,
postoperative follow–up, hematology, serum biochemical and blood
gas results, radiographic and ultrasonographic diagnostic imaging
information could not be obtained because the patient owner could
not be reached during the postoperative period were not included
in the study.
This study protocol was approved by the Local Ethics Committee on
Animal Experiments, Harran University (session and permit number:
2024/001/04).
Clinical and laboratory examinations
Within the scope of clinical examinations, body temperature, pulse
rate and respiratory rate were evaluated with Mindray UMEC12VET
(Mindray UMEC12VET, Shenzhen Mindray Bio–Medical Electronics Co,
Shenzhen, China) device before the surgical procedure. Hemogram,
serum biochemistry and blood gas analysis were performed. For
hemogram, white blood cell (WBC), lymphocyte, monocyte, red
blood cell (RBC), mean corpuscular volume (MCV), hematocrit,
mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin
concentration (MCHC) and hemoglobin levels were measured using
a hematology auto analyzer (pocH–100i®, Sysmex, Kobe, Japan).
For biochemical evaluation, serum glucose, creatinine, cholesterol,
alanine aminotransferase (ALT), aspartate transaminase (AST), total
bilirubin, albumin, C–reactive protein (CRP) levels were determined
using an automated biochemistry analyzer (Spotchem EZ SP 4430®,
Arkray Inc. , Kyoto, Japan). Hydrogen ion concentration (pH), partial
pressure of oxygen (pO
2
) and partial pressure of carbon dioxide (pCO
2
)
analyses of heparinized blood samples were performed with GEM
Premier Plus 3000 (74351, Blood Gas/Electrolyte Analyzer, Model
5700, Instrumentation Laboratories, USA) autoanalyzer.
Radiographic and ultrasonographic evaluation
The initial diagnosis of RVF associated with AA was based on the
results of physical examination and observations of perivulvar fecal
contamination. In addition, considering the presence of feces in
the vulva, a probe or forceps was inserted gently into the vulva and
rectum. Radiographic (838 HF50, Hasvet, China) and ultrasonographic
(Z60 VET, Mindray, China) examinations were performed for detailed
diagnosis. Radiographs were taken in lateral and ventrodorsal positions
including the abdomen and pelvis to determine the degree of colonic
dilatation, caudal width of the rectum and type of AA and to evaluate
any sacrococcygeal anomaly. Radiographs were taken with a Hasvet
838 HF50 70KV – 50mA veterinary por table DR x–ray machine and
digitally evaluated. Ultrasonographic examinations of the anorectal
region were performed similar to the technique described by Kleinübing
et al. [13]. In ultrasonographic examinations, all images were obtained
FIGURE 1. Case 11 a) Closed anal area (white arrow), feces in perivulvar
area (black arrow). b) Detection of fistula in closed anal area with guiding
forceps from vulva (white arrow). c) Fistula in anoplasty area (arrowhead). d)
Postoperative rectal suture (white arrow), suture of stula canal (arrowhead).
e) Postoperative area. f) Fecal output (black arrow)
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using an ultrasound machine (Z60 VET, Mindray, China) with a 7.2 to 11
MHz microconvex probe. Animals were placed in the sterno–abdominal
position and transperineal ultrasonography was used to examine the
presence, length, location and positioning of the RVF in relation to the
rectum. Furthermore, according to the proximity and distance of the
14]. All assessments were recorded.
Treatment and surgical technique
All surgical procedures were performed under sedation and local
anesthesia in the sterno–abdominal position with a perineal approach.
Initially, the animal was anesthetized and then placed on the operation
back and removed from the operation area and the perineal area was
prepared for the surgical procedure.
In the anesthesia protocol applied to the animals, 2% Xylazine
(Rompun® 0.02– 0.34 mg·kg
-1
, intramuscular) was used as a
preanesthetic agent. Induction and maintenance of anesthesia was
achieved by administration of Propofol (Propofol–PF 1% 3 mg·kg
-1
intravenously). Subsequently, lower epidural anesthesia was
performed in the lumbosacral region using the local anesthetic 2%
Lidocaine (Jetocaine® – 0.1 mL·kg
-1
, epidural).
The subjects were placed on the operation table in the sterno–
abdominal position with their hind legs stretched posteriorly
and shaving and antisepsis of the operation area was performed
by brushing with 10% Povidone Iodine and rinsing with 70% ethyl
alcohol. After the operation area was delimited with sterile cervical
cloths, a "+" shaped skin incision was made in the perineal region. The
incision lines varied according to the size of the patient, but were 2×3
cm in diameter in lambs and 5×8 cm in calves. The vertical incision
was bordered dorsally and ventrally by the base of the tail and the
dorsal commissure of the vulva, respectively. Following careful blunt
dissection of the connective tissue in the area and the medial line
of the external anal sphincter muscle, the path of the rectovaginal
the help of a hemostatic clamp inserted from the vulva, two ligatures
was reversed to the ventral wall of the rectum and the dorsal wall of
was then closed by applying simple separate sutures with 2–USP PGA
absorbable thread (FIGS. 1, 2).
This area was further defined by meticulous division of the
subcutaneous tissue around the blind fundus pouch of the rectum,
which is located more dorsal to the fistula area. Anoplasty was
continued to reconstruct the anal canal and anus. Accordingly, before
transection of the distal part of the blind inferior pouch, a circular
skin opening was created by cutting the apexes of the skin incisions,
with a separate single layer of 2–USP non–absorbable silk thread.
Thus, the anus tract was opened to the outside and fecal output was
observed in most of the cases (FIGS. 1, 2).
Postoperatively, Meloxicam (2.2 mg·kg
-1
, Metacam®, Terrassa,
Barcelona Spain) and Vetimycin 8mg·kg
-1
(Vetas, DEVA Holding) were
(Sokol liquid, 200 mL, Biofarma) was recommended to be administered
orally 15 mL twice daily until normal defecation begins. Since it was
challenging to keep the surgical area clean due to feces, the area was
cleaned with povidone iodine (Baticonol 10%, DERMOSEPT) three times
a day. Soapy water enemas have also been recommended if necessary.
Postoperative follow–ups were conducted via telephone with
the patient owners. During the 6–month follow–up, questions were
asked whether any complications occurred and the owners stated
FIGURE 2. Case 1 a) Closed anal area (white arrow). b) Fistula in the anoplasty
area (arrowhead). c) Suture of the stula canal (arrowhead). d) Postoperative
area (black arrow)
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between 3 and 540 d of age. In patient number 4 (1 of 9, frequency 11%),
the owner reported that the animal defecated from the female organ
until the age of 1.5 years and it did not affect its life, but it was brought
for treatment due to severe constipation and enlargement of the
of 8, 75%) and 2 were Hollstein (2 of 8, frequency 25%). The species,
and prognosis of all cases are presented in TABLE I.
the perivulval area, abdominal distension, partial perineal swelling
and hematochezia in cases 4, 9 and 13 (3 of 17, frequency 17%) were
encountered in the majority of cases. Preoperative hemogram, serum
biochemistry and blood gas analyses were within the normal reference
range in all cases and no intraoperative or postoperative complications
were encountered. Laboratory values are shown in TABLE II.
that the patients experienced constipation for 3–5 days (d) in the
postoperative period, but no other complications were observed.
Especially in the calf cases, at the end of the 6th month, the owners
asked if they could have calves from the patients in the future and
relevant recommendations were presented.
Statistical analysis
SPSS statistical package program was utilized for all calculations
and statistical analyses in the study and descriptive statistical analysis
software was applied. The data sets were evaluated for normality
using the Shapiro–Wilk normality test and the data sets displayed
intervals were calculated and comments were provided accordingly.
RESULTS AND DISCUSSION
In the study, a total of 17 female ruminants, 9 lambs and 8 calves,
were diagnosed with RVF associated with Type– II AA. Based on
the anamnesis information obtained from the owners and clinical
RVF. In lambs, RVF associated with congenital Type–II AA was observed
TABLE I
Summary of diagnosis, disease and treatment information of cases (n=17)
Case Animal Diagnosis RG USG Prognosis
1
Lamb, 4–day,
Female, Awassi
Atresia
ani type II
with RVF
Abdominal
distension, dilated
colon, severe
megacolon
Recto– lower
vaginal stula
After 6 months,
no complications
2
Lamb, 1.5–month,
Female, Awassi
Atresia
ani type II
with RVF
Dilated colon,
mid megacolon
Recto– lower
vaginal stula
After 6 months,
no complications
3
Lamb, 2–month,
Female, Awassi
Atresia
ani type II
with RVF
Abdominal
distension,
dilated colon,
mid megacolon
Recto– lower
vaginal stula
After 6 months,
no complications
4
Sheep, 1.5–year,
Female, Awassi
Atresia
ani type II
with RVF
Abdominal
distension, mid
megacolon
Recto– lower
vaginal stula
After 6 months,
no complications
5
Lamb, 3–day,
Female, Awassi
Atresia
ani type II
with RVF
Abdominal
distension, dilated
colon, severe
megacolon
Recto– lower
vaginal stula
After 6 months,
no complications
6
Lamb, 15–day,
Female, Awassi
Atresia
ani type II
with RVF
Abdominal
distension,
dilated colon
Recto– lower
vaginal stula
After 6 months,
no complications
7
Lamb, 10–day,
Female, Awassi
Atresia
ani type II
with RVF
Abdominal
distension,
dilated colon
Recto– lower
vaginal stula
After 6 months,
no complications
8
Lamb, 3–day,
Female, Awassi
Atresi ani et
vulvi type
II with RVF,
Lack of tail
Abdominal
distension,
dilated colon
Recto– lower
vaginal stula
After 6 months,
no complications
9
Lamb, 2–month,
Female, Awassi
Atresia
ani type I
with RVF
Dilated colon,
mid megacolon
Recto– lower
vaginal stula
After 6 months,
no complications
10
Calf, 1–day,
Female
Simmental
Atresia
ani type II
with RVF
Abdominal
distension,
dilated colon,
mid megacolon
Recto– lower
vaginal stula
After 6 months,
no complications
11
Calf, 7–day,
Female
Simmental
Atresia
ani type II
with RVF
Abdominal
distension,
dilated colon,
mid megacolon
Recto– lower
vaginal stula
After 6 months,
no complications
12
Calf, 32–day,
Female,
Simmental
Atresia
ani type II
with RVF
Dilated colon,
severe megacolon
Recto– lower
vaginal stula
After 6 months,
no complications
FIGURE 3. Case 11, a) Visualization of abdomen and pelvis in lateral position,
dilated colon and moderate megacolon, (0.9 cm=Type II). Case 1, b) Preoperative
visualization of abdomen and pelvis in lateral position, clear detection of closed
sac, dilated colon and severe megacolon, (0.5 cm= Type II). Case 1, c) Postoperative
anoplasty procedure resulting in an opened anal canal (black arrow)
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scheme, the radiographic evaluation of type II AA was expressed as
the distance between the anus (<1 cm) where the imperforate rectum
terminated close to the closed anus (FIG. 3).
completely on ultrasonographic evaluation. In Case 16 and 17 (2 of
17, 11%), ultrasonographic evaluation was not possible due to closed
Choi et al. [14]. According to the scatter plot of perineum–pouch (P–P)
mean P–P distances for Upper and Lower type AA with RVFs were
established as 6–30 mm and 0–14 mm, respectively. [14, 16]. Type II
TABLE I
Summary of diagnosis, disease and treatment information of cases (n=17) cont...
13
Calf, 7–day,
Female,
Simmental
Atresia
ani type II
with RVF
Abdominal
distension,
dilated colon,
mid megacolon
Recto– lower
vaginal stula
After 6 months,
no complications
14
Calf, 2–day,
Female, Hollstein
Atresia
ani type II
with RVF
Abdominal
distension,
dilated colon,
mid megacolon
Recto– lower
vaginal stula
After 6 months,
no complications
15
Calf, 3–day,
Female,
Simmental
Atresia
ani type II
with RVF
Dilated colon,
mid megacolon
Recto– lower
vaginal stula
After 6 months,
no complications
16
Calf, 30–day,
Female,
Simmental
Atresia
ani type II
with RVF
Abdominal
distension, dilated
colon, severe
megacolon
No assessment
After 6 months,
no complications
17
Calf, 26–day,
Female, Hollstein
Atresia
ani type II
with RVF
Abdominal
distension, dilated
colon, severe
megacolon
No assessment
After 6 months,
no complications
RG: radiographic imaging, USG: ultrasonographic imaging
TABLE II
Haematological, biochemical and blood gases results. Mean ± SD
Parameter Test Results Lambs Calves
WBC 9.82 ± 0.59 13.69 ± 2.50
Lymphocyte 55.66 ± 0.08 16.06 ± 9.83
Monocyte 2.55 ± 0.02 0.88 ± 1.12
RBC 9.55 ± 2.55 8.79 ± 3.40
MCV 35.11 ± 4.31 38.20 ± 3.35
Hematocrit 29.48 ± 1.22 37.55 ± 3.56
MCH 9.12 ± 2.77 14.47 ± 3.49
MCHC 31.34 ± 0.65 31.55 ± 1.81
Haemoglobin 12.11 ± 2.30 11.86 ± 1.19
Glucose (mmol·L
-1
) 3.60 ± 1.23 4.22 ± 0.50
Creatinin (µmol·L
-1
) 129 ± 5.7 142 ± 5.9
ALT (U·L
-1
) 29.62 ± 3.26 31.21 ± 1.18
AST (U·L
-1
) 118.10 ± 9.21 123.8 ± 2.50
Total–Bilirubin(mg·dL
-1
) 0.36 ± 0.50 0.23 ± 0.68
Albumin (g·dL
-1
) 2.33 ± 0.45 2.40 ± 0.97
CRP (mg·dL
-1
) 0.69 ± 0.31 0.54 ± 0.58
pH 7.43 ± 0.01 7.41 ± 0.32
pCO
2
40.66 ± 3.53 44.60 ± 2.65
pO
2
39.15 ± 1.85 30.44 ± 2.46
In all animals, direct radiographs taken before treatment
demonstrated gaseous distension of the intestinal segments and
megacolon. Furthermore, no other congenital anomalies were
detected in the radiographic evaluation of the pelvis and abdominal
region. In radiographic imaging, using a common classification
scheme with other literatures [15
was observed in all cases based on the distance between the closed
bb
FIGURE 4. Case 11, a) Transperineal USG, Grayscale image shows a hypoechoic
stula (black arrow) on the right side of the anal canal. Marked hypervascularity on
color Doppler study near the perianal region of this stula. Case 1, b) Transperineal
USG, air bubbles in the closed perianal region (arrowhead), wider stula channel to
the right of the rectum (black arrow). R = Rectum, F = Fistula,
P = Probe
Ruminant Atresia Ani: Diagnosis and Repair of Rectovaginal Fistulas / Yener et al.__________________________________________________
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AA type overlapped with the Lower type reference interval and recto–
P<0.005)
in the patients who could undergo ultrasonographic evaluation (n:15).
procedure and radiographic observation of recto–lower vaginal
hypoechoic areas between the rectum and urethra. Especially in cases
2, 6 and 11 (3 of 17, 17%), color Doppler study (Z60 VET, Mindray, China)
(FIG. 4).
Although the presence of infection in these areas was considered, it
did not pose a risk for later periods considering the hematologic values
and the operation process. Considering both imaging modalities, it
the typing of atresia and ultrasonography was more useful in the
surgical procedure.
as megacolon, chronic renal damage, cystitis, vaginitis, cervicitis,
endometritis, failure to conceive and reproductive failure [6, 17, 18].
In this clinical study, 9 lambs and 8 calves with AA–associated RVF
cases had a better prognosis postoperatively than preoperatively
with correct diagnosis and diagnosis.
In ruminants, RVF cases with AA may be associated with other
congenital anomalies such as vulvar agenesis, atresia coli, atresia
ani et vulvi and partial tail agenesis [6, 19, 20, 21, 22]. Among the cases
analyzed in this study, tail agenesis was observed in only one lamb (case
8) and no other congenital anomalies were observed in the other cases.
In the literature, the incidence of AA–associated RVF cases in
ruminants is low and has been reported in approximately 22 lambs and
calves [1, 2, 22]. Among the reported cases, it is noteworthy that the
number of calves is higher and especially buffalo and native calf India
breeds are more common [23]. In lambs, mostly crossbreds have been
reported [8]. In this study, awassi lambs (n:9) and simmental (n:6) and
holstein (n:2) calves were included. In addition, odds ratio evaluation
revealed that lambs were 2 times more likely to be observed (P<0.005).
as anal stenosis, distance between rectum and bladder [7]. In all data,
RVF has been reported to be mostly associated with type II AA and
very few with type III AA in both lambs and calves and other animals
such as cats and dogs [23, 24
imaging diagnostic methods and surgical procedure, all cases in
the present study were found to be RVF associated with type II AA.
of congenital diseases such as AA and RVF, different diagnostic tools
such as radiography, ultrasonography, computed tomography (CT)
and magnetic resonance imaging (MRI) are required in cases such as
of anomalies in the pelvic region, determination of the exact size of
the colon to rule out possible megacolon, diagnosis of urinary tract
infections, detection of anomalies in other organs in the abdomen, and
prognosis of the disease and acceleration of the surgical procedure [1,
4, 10, 25]. In the study of Fernandes et al. [26], involving Type II AA with
RVF cases reported in 2 calves, it was emphasized that examinations
such as radiography and ultrasound should be used as they help to
determine the position of the colon and rectum relative to the perianal
region [26]. In another study presented by Bae et al. [24], radiography
but it was reported that it should be supported by methods such
as ultrasonography and computed tomography (CT) [24]. Ryu et al.
reported that contrast radiography was useful in determining the
Anoplasty was performed in all cases (n:17) and RVF was surgically
closed when available. Sutures were removed 10–12 d after the
procedure. Animals were able to defecate normally 7–10 d after the
surgical procedure. Six months after the surgical procedure, the
animals were re–evaluated and no complications were detected.
In the statistical evaluation, TABLE III shows whether the disease
is associated with species and race. As a result, when TABLE III
was analyzed, the predisposition of breed and species was found
P<0.05). Awassi breed lambs were
determined as the most disadvantaged breed in terms of this anomaly.
Within–group evaluation revealed that lambs had a 2–fold more
disadvantageous predisposition to this anomaly than calves and
(P<0.05).
AA is a congenital deformity caused by a genetic defect in the
perianal region in which the dorsal part of the anus opening to the
outside is not formed. RVF is a congenital disease characterized by the
failure of the urorectal septum to close due to an embryologic defect.
These two diseases occur together, especially in ruminants, and when
left untreated, they lead to poor prognosis and economic losses such
TABLE III
Analysis results and odds ratio values for the orientation
of AA with RVF disease by species and breeds.
Anomaly Races Total
Odds
Ratio*
95% Wald’
Condence
Interface
X²
(P-value)
Type II AA
with RVF
Awassi 9 2,000 1,418– 57,117
13,432
a
(P=0,000)
Simmental
8 0,111 0,018– 0,705
Holstein
*: Simmental or Holstein groups were combined under the same group and the risks
were calculated based on the group including Awassi breed.
a
: 4 cells (100,0%) have
expected count less than 5. The minimum expected count is 3.76
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with RVF [23]. In the present study, all cases were evaluated both
radiographically and ultrasonographically. Consequently, radiography
was utilized in AA typing and ultrasonography was utilized in the
In the radiographic evaluation of AA cases, type I (0 cm) = imperforate
anus, type II (<1 cm) = imperforate anus, type III (>1 cm) = imperforate anus
the perineal region [15]. In the case study presented by Choi CK et al,
RVF with Type III AA was diagnosed as RVF with Type III AA as a result of
the observation of an imperforate anus in a cat (Felis catus) in which the
perineal skin of the rectum terminated with a blind pouch approximately
27]. Kurt and Turan, observed that the
blind rectal pouch was 1.07 cm away from the anal pouch with lateral
with RvF [7]. Kim et al. also reported that the distance between the blind
rectal pouch and the perineal sac on radiographic imaging was 1.2 cm,
indicating a type III AA with RVF [16]. Ellison and Papazoglou, measured
the distance between the blind rectal sac and perineal skin as 1.5 cm in
the right lateral radiographic imaging of a 7–week–old female French
Bulldog and reported Type III AA [9]. In the present study, when lambs
and calves were radiographically categorized, the diagnosis of Type II
(P<0.005).
In a retrospective study of pediatric patients with atresia presented
by Haber et al. [28
was diagnosed in 4 patients. It was emphasized that in patients who
underwent transperineal ultrasonographic approach, a complete
has been reported to prevent unnecessary colostomy in some
of atresia ani, especially when a fistula cannot be detected on
clinical examination [28]. Hwang et al. performed ultrasonographic
Doppler evaluation of some cases, the presence of hyperemia in
subjective evaluation [29]. In the study conducted in lambs and calves,
transperineal ultrasonography was utilized in the evaluation of the
diagnosed in the evaluable cases (n=15) supported by radiography and
longitudinal tubular hypoeocic areas similar to other studies. Although
infection was considered in the colored areas in Doppler evaluation,
there is not enough data on ultrasonographic evaluation of recto–
literature, it is believed that more studies are required.
Two surgical techniques are commonly used in cases of recto–
based on anoplasty, in which the area is accessed by incising the
sutured, and then the ends of the rectum are sutured to the anus and
by closing the rectum and vulvar defects separately [23, 26]. This
technique has also been reported by Ziaullah and Shahzad, in a case of
type II atresia ani with RVF in a dog (Canis lupus familiaris) by applying
[30
the vulva with forceps or catheter and opening the rectum with a "
+" incision from the closed skin caudal part of the rectum under the
around the anus with sutures. In addition, similar to Jardel et al. [31],
the "rectal pull through" technique was used in the surgical procedure
performed without the need for another incision. This technique is
thought to be less invasive with minimal tissue damage.
In some studies, a syringe cut chamber of various sizes was placed
into the rectum after the operative procedure. It has been reported that
and anal sphincter and keeps the sutures clean [8, 12, 27, 32]. This
material was not used in the present study. Postoperative wound care
was performed 3 times a day and no complications were encountered.
Possible complications following surgical treatment include
tenesmus, depression, abdominal distension, megacolon due to
constipation, fecal incontinence and rectal prolapse due to surgical
trauma [4, 25, 26]. In our study, constipation was observed in the
postoperative period and resolved with treatment. Besides, no
complications related to surgical trauma were encountered.
CONCLUSION
It is considered that the prognosis of AA with RVF disease, which
can lead to serious complications and economic losses when left
anoplasty procedure using the rectal pull through technique. In
addition, it is concluded that not only clinical and physical evaluation
but also radiographic and ultrasonographic evaluations are very
crucial for the diagnosis and treatment of this disease.
Conicts of Interest
interest.
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