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      Date:   07 February, 2015  
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Surgery Of The Canine Circum-anal Tumours 
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
First written: 12 June 2010
D
ate:  07 February, 2015
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Be Kind To Pets
Veterinary Education
Project 2010-0129

INTRODUCTION

Certain breeds (e.g. Siberian Husky), old dogs and not neutered males are more prone to perianal (circum-anal) gland tumours. The majority of tumours are benign and are called perianal (circum-anal) adenomas. The malignant ones are called adenocarcinomas. They can't be differentiated by visual inspection. A histopathology of the excised tumour is needed to check whether it is cancerous.
 
TREATMENT - 3 OPTIONS
1. Surgical excision. Some vets don't perform this surgery as there may be worries of the wound not being able to heal and close. The client may get very angry as the dog will keep licking the open wound.  Old dogs may die under general anaesthesiaC on the operating table leading to highly emotional scenes and potential litigation.

These are two main reasons why some vets don't want to operate. The owner may need to seek a vet who will operate as the dog licks the infected tumours to relieve its pain. Blood dripping from the backside can be quite inconvenient to the owner. Owners may need to be proactive in seeking early surgical removal.
 
 
A February 2015 case of circum-anal tumours in a male, not neutered Siberian Husky
Video: A male 8-year-old Husky has circum-anal tumours Pt 1
Video: Circum-anal tumours cleaned Pt 2
 

2. Neutering. Perianal gland tumours are most common in male dogs that are not neutered. It is rarer in female dogs. In this case study in 2010, a female spayed Siberian Husky had one such tumour.

3. Hormone treatment.
Tardak is an anti-androgenic hormone. Injections may be effective but need to be given regularly when tumours occur. Tardak is for use in male dogs and cats in the following indications:

3.1 The treatment of hypersexuality (humping, wanting to stray).

3.2 The relief of prostatic hypertrophy whether benign, carcinomatous or when due to chronic inflammatory processes. In inflammation, antibiotics and anti-inflammatory drugs are used too.

3.3 For the treatment of circum-anal (perianal) gland tumours.

3.4 For the treatment of certain forms of aggressiveness, nervousness, epileptiform seizures and corticoid-resistant pruritus (developing into dermatoses and accompanied by alopecia).

4. Chemotherapy and radiation for cancerous types. This is not normally available for Singapore dogs.

A 2010 CASE STUDY
Female spayed Siberian Husky, 11 years old suffered from blood dripping from her circum-anal tumour for over 4 months. The tumour ulcerates and become infected. If you see the black spot below and to the right of the anus, there were early signs of perianal gland irritation, as the black spot is due to continual licking over several weeks.

CHALLENGES
1. High anaesthetic risk as in all old dogs. The owner did not wish to have a blood test. The vet must inform the owner of the need for such a test to screen the health of the dog before anaesthesia and surgery.

2. Large tumour over 3 cm x 3 cm very close to the anus. That meant a large wound after removal of the tumour and difficulty in achieving normal closure.

3. The dog passes soft stools during surgery, resulting in possible contamination during surgery and after.

4.  If the dog rubs her backside on the floor after surgery, the stitches may break down. A large e-collar prevents licking of the wound.

PLAN AHEAD

The owner's vet who did not want to operate. The dog had a full grooming esp. of the tail area, ensuring that there were no maggot wounds. I prescribed oral Baytril antibiotics for 6 days.

PRE-ANAESTHESIA
On the 6th day, the wound was not infected. The dog's rectal temperature could not be taken as the dog struggled and leaked out urine whenever her tail was to be held up for the insertion of the thermometer into the rectum. She was in great pain in the anal area and tried to bite to defend herself. More urine leaked out as she struggled. I got her muzzled for the IV drip and the injection via the IV catheter of Domitor 0.15 ml.

ANAESTHESIA
The dog was shaved. Isoflurane gas was given by mask. I intubated the dog and gave isoflurane at 1-2% ensured surgical anaesthesia. I got a towel to cover the metallic operating table to prevent electrical shock when I used electro-surgery to excise the circum-anal tumour. A swab with saline was placed on the indifferent plate and the dog's belly for the conduct of electricity during electro-incision and cautery.

SURGERY, JUNE 9, 2010 FROM 2.17 PM - 3.15PM
1. I used electro-incision to cut off the tumour. The dorsal part has a dark red mass of 0.5 cm x 0.5 cm. The main mass was hard, nodular and ulcerated. It was 2.5 cm x 2.5 cm. The shorter the surgery, the better the chances of survival.

2. A small artery at the ventro-lateral area nearer and below the anus spurted out red blood. I ligated 3 times. Coagulated the bleeding point. Finally, there was not much bleeding.

3. As the elliptical gap was large and under high tension, I had to reduce the tension in order to enable good wound healing. I extended the skin incision to the left at the dorsal and ventral edges above and below the anus respectively (see illustration). The wound was stitched with 3/0 sutures.

Old Siberian Husky, female, spayed, perianal, circum-anal gland tumour, singapore, toa payoh vets Old Siberian Husky, female, spayed, perianal, circum-anal gland tumour, singapore, toa payoh vets The anus must be plugged to prevent stools from contaminating the surgical wound with bacteria. A 3-ml syringe was initially used.  
     
Old Siberian Husky, female, spayed, perianal, circum-anal gland tumour, singapore, toa payoh vets Old Siberian Husky, female, spayed, perianal, circum-anal gland tumour, singapore, toa payoh vets Electro-incision is very useful when the tumour is one discrete lump. No bleeding at all. The profuse bleeding is due to a small artery on the lower left shooting out blood. It was ligated.
   
Old Siberian Husky, female, spayed, perianal, circum-anal gland tumour, singapore, toa payoh vets Copious soft yellow stools leaked out only during anaesthesia. I switched to a 10-ml syringe but still the stools flowed. In retrospect, a spasmogesic injection IV should be given in this case. Anaesthesia was very low. This could be deepened but this old dog might just die. 
   
Old Siberian Husky, female, spayed, perianal, circum-anal gland tumour, singapore, toa payoh vets Note the loose reddish tissues outside the anus. This indicated a partial rectal prolapse due to continual irritation of the rectum by loose stools over the years.
   
I illustrate the surgical techniques used for my record and review. The owner was given the original copy. This surgery can result in a big contaminated wound and lots of cursing by the unenlightened owner if the stitches break down and if the owner does not do proper nursing consequentially.  Old Siberian Husky, female, spayed, perianal, circum-anal gland tumour, singapore, toa payoh vets

4. During closing, this dog kept passing out the loose stools despite her rectum being plugged by a 3-ml syringe. The stools would fall onto the surgical wound and this would be terrible. The wound would be contaminated and would not heal. "Get me a 10-ml syringe," I asked my assistant. The 10-ml syringe plugged the rectum. Still the stools flowed out from the side. I had to be careful to wipe the stools away while I quickly stitched up. 

This was be possibly due to the minimal isoflurane gas being used and therefore the dog's defaecation reflex was present. The dog's tongue was not a healthy pink and sometimes it turned cyanotic. Since the owner did not want a health screening blood test, it would be difficult to know if this dog had anaemia, hypercalcaemia, kidney or liver disorders.

POST SURGERY
The dog woke up within 10 minutes as if she had a good nap of over 30 minutes.
I gave 2.5 ml of anti-spasmogesic IV to prevent more loose stools coming out to contaminate the wound. She wore an e-collar. She was the nervous type.  The owners visited her in the evening. "Was the lady owner able to check out the surgical area?" I asked Mr Saw, my assistant. Every time we tried to lift the tail, this dog would panic and void a large volume of yellow urine. I phoned the owner to take the dog home as this seemed to be in the interest of the dog. 

HISTOPATHOLOGY
The vet must inform the owner that there is histopathology to verify whether the tumour is cancerous or benign. In this case, the owner did not want this test. 

CONCLUSION
Neutering and surgical excision are recommended. Tumours are best removed when they are very small. I advise two anti-androgenic injections post surgery at 2-weekly intervals. Neutering your male dogs when they are young and/or weekly examination of the anal area will ensure that your dog live longer. This case has a happy ending. It is best that the owner gets the tumours excised when they are very small in size.

UPDATE ON JUN 10, 2010
1. The owner visited her yesterday evening after the surgery. The dog permitted only the lady owner to lift his tail to look at the surgical site. I suggested that the dog go home.

2. The lady arranged for the dog transport man to bring the dog home. She came to the Surgery at 5 pm on Jun 10, 2010 to wait for the transport man.

3. Although she did not pay for the blood test, I showed her the results. The blood urea was high. It was 14.4 (normal  = 4.2 to 6.3). Creatinine was within normal range at 117 (89  -177).

Total White Cell Count was high at 18.2 (normal = 1 - 17) despite 6 days of 2.5 tablets of Baytril 50mg for this 25 kg weight, before the blood test. Neutrophils 83.5% (normal 60-70%), Lymphocytes 6.7%, Monocytes 9.3%,  Eosinophils 0.06% and Basophils 0.55%. I considered this result not to be a health threat.

4. I advised the owner that continuous passage of loose stools will result in rectal prolapse. She confirmed that she saw some rectal tissues coming out of the anus. It is possible that the dog may not tolerate dry dog food or could be allergic to the components of ordinary dry dog food. Passing loose stools over several years may result in rectal prolapse or intusussception.

5. Unusual behaviour of this older dog. Whenever she is restrained, she would "wet her pants". A lot of urine would shoot out. It seems that she withholds urine as this incident happens more than 4 times during restraint before and after surgery. This could be a behaviour of excitation urination.

6. Home nursing. A small spray bottle filled with warm water. Spray onto the surgical wound to remove faeces or blood. Gently touch with tissue paper. Painkillers tolfedine to be given for next 4 days. E-collar to be worn. This dog was happier at home as she seemed to be frightened of veterinary staff and vets.  

7. I hope all will be well with this old dog and that the tumour will not recur. A blood health screening in older dogs will always be good for the dog and the owner as diseases shown can be treated or prevented.

UPDATE ON JUN 10, 2010
The lady owner phoned me. "The stitches have broken down but the dog will not allow me to lift the tail to see the wound."
"Don't worry," I said. "The tolfedine pain-killers would work soon. Did the dog pass stools?"
"Yes, one small brown bit. Solid stool."
"That's good," I said. The dog was off dry food for the past 48 hours. My spasmogesic injection IV had slowed down intestinal peristalsis permitting the stool to be well formed.  Did the stitch break down due to the dog licking the wound? I forgot to ask whether the dog was wearing an e-collar. No further news from the owner.
      

See two of my other cases:

2010 CIRCUM-ANAL TUMOUR IN AN OLD INTACT MALE SHIH TZU
Four months after perianal (circum-anal) tumour surgery - Circum-anal tumours in dogs in Singapore

2015 CIRCUM-ANAL TUMOUR IN AN OLD INTACT MALE SIBERIAN HUSKY 
Video: A male 8-year-old, not neuterd Husky has circum-anal tumours Pt 1
Video: Circum-anal tumours cleaned Pt 2

To make an appointment: e-mail judy@toapayohvets.com
tel: +65 9668-6469, 6254-3326

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Project 2010-0129
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