Long-term results of surgery for atresia ani

SMALL ANIMALS

with or without anogenital malformations

in puppies and a kitten: 12 cases (1983–2010)
Gary W. Ellison, dvm, ms, dacvs, and Lysimachos G. Papazoglou, dvm, phd

Objective—To evaluate signalment, clinical findings, surgical treatment, and long-term out-
comes in puppies and kittens after surgical repair of various types of atresia ani (AA) with or
without concomitant anogenital or rectogenital malformations.
Design—Retrospective case series.
Animals—11 puppies and 1 kitten.
Procedures—Medical records of 2 veterinary teaching hospitals were reviewed for puppies
and kittens that underwent surgical treatment for AA. Information regarding signalment,
diagnosis, surgical procedures, follow-up time, and outcome was recorded. A previously
described classification scheme was used to classify AA as type I, II, III, or IV. Follow-up
times and outcomes were evaluated.
Results—AA was classified as type I in 3 animals, type II in 6, and type III in 3. Nine of
12 patients had anogenital or rectogenital malformations; 8 of these had rectovaginal fis-
tulas. Eleven animals underwent in situ anoplasty, and 1 underwent surgery in which the
rectovaginal fistula was used for anal reconstruction. Six also underwent balloon dilation
for treatment of anal stenosis, and revision anoplasty was performed in 5. All patients
with type I or II AA survived ≥ 1 year. Two puppies with type III AA were euthanized 3 and
40 days after surgery. Follow-up time for the remaining 10 patients ranged from 12 to 92
months, and 3 had fecal incontinence.
Conclusions and Clinical Relevance—Surgical repair of type I or II AA resulted in long-
term survival and fecal continence in most cases. Although numbers were small, patients
with type III AA had poorer outcomes than did those with type I or II AA. (J Am Vet Med
Assoc 2012;240:186–192)

A tresia ani and concomitant RVF have been described

in several case reports of dogs1–8 and cats.9–11 The
condition may be more common in small animals than AA Atresia ani
Abbreviations

has been reported because most neonates are euthanized
at the time of diagnosis.12 Clinical signs or physical
anomalies in puppies and kittens with AA include te-
nesmus, abdominal distension, bulging of the perineum,
and stenosis or absence of an anal orifice. In females with
concomitant RVF, feces may be excreted through the vul-
va. Many cases of AA are not recognized until weaning,
when tenesmus and abdominal distension become more
noticeable. Most affected animals described in the vet-
erinary literature have been females, and many have had
concomitant RVFs.1–8 Various degrees of fecal impaction
and colonic distension are typically apparent on radio-
graphic examination.
Among domestic animals, AA is most commonly
reported in pigs.13 The condition appears to be more
rare in dogs. In 1 study,8 a review of records from 1964
to 2003 in the Veterinary Medical Data Base maintained
at Purdue University indicated the overall incidence of
AA in dogs was 0.007%, with a female-to-male ratio
From the Department of Small Animal Clinical Sciences, Health Sci-
ence Center, College of Veterinary Medicine, University of Florida,
Gainesville, FL 34610 (Ellison); and the Department of Clinical
Sciences, Faculty of Veterinary Medicine, Aristotle University of
Thessaloniki, 54627 Thessaloniki, Greece (Papazoglou).
Address correspondence to Dr. Ellison (ellisong@vetmed.ufl.edu).
RVF Rectovaginal fistula
of 1.79:1. The anomaly was reported more commonly
in purebred dogs, and incidence was significantly in-
creased in the Finnish Spitz, Boston Terrier, Maltese,
Chow Chow, German Shorthaired Pointer, Miniature
Poodle, Toy Poodle, and Miniature Schnauzer breeds,
compared with mixed-breed dogs.8 To the authors’
knowledge, the incidence of AA in cats has not been
described, but the case reports9–11 that are available sug-
gest the condition develops more frequently in females
with concomitant RVFs.
Atresia ani develops during formation of the em-
bryo when normal separation of the primitive cloaca
into the rectum and urogenital sinus by the urorectal
fold is not completed, and imperforate anus results
from failure of anal membrane opening after anal de-
velopment in the fetus.14 Atresia ani and imperforate
anus have been described in humans, and classification
schemes grading these as types I through IV were de-
veloped to categorize the severity of AA and to compare
success rates of various surgical procedures as they ap-
plied to distinct types of the anomaly.15–17
A classification scheme similar to that used in hu-
mans has been described in dogs.8 A type I classification

186 Scientific Reports JAVMA, Vol 240, No. 2, January 15, 2012

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denotes anal stenosis without imperforate anus. Usual-
ly, there is communication of the anus with the rectum
and attenuated meconium or fecal material is present
at the anus; a partial anal membrane is sometimes pres-
ent. Type II anomalies consist of an imperforate anus
attributable to persistence of the anal membrane; the
rectum ends as a blind pouch in close proximity to the
closed anus. The pouch sometimes causes inward de-
flection of the perineal skin (ie, anal dimple), and the
external anal sphincter and anal sacs are usually pres-
ent.5 In type III anomalies, the anus is also imperforate,
with the rectum terminating more cranially in a blind
pouch.8 Dogs with type III AA often lack an anal dimple
and may have agenesis of the anal sacs, external anal
sphincter, or tail (alone or in combination).4,5,7 In some
reports,5,18 dogs with type III AA and concomitant RVF
were also described as having an ectopic anus. Type IV
anomalies involve a discontinuity of the proximal por-
tion of the rectum, typically with normal development
of the anal canal and anus.8 In dogs, these classification
schemes have been inconsistently applied in clinical re-
ports.1–8 To the authors’ knowledge, no reports have de-
scribed type IV AA in nonhuman animals and no pub-
lished veterinary studies have reported success rates for
treatment of these specific types of AA.
The purpose of the study reported here was to eval-
uate the signalment, clinical findings, surgical treat-
ment, and long-term outcomes of puppies and kittens
that underwent surgery for AA with or without con-
comitant anorectal or anogenital malformations. We
retrospectively classified these patients according to an
existing scheme8 to identify potential associations be-
tween the various types of AA and long-term outcome
following surgical treatment.
Materials and Methods
Criteria for selection of cases—Hard copy and
computer-based medical records of the University of
Florida Veterinary Medical Center and the Compan-
ion Animal Hospital of Aristotle University in Thessa-
loniki, Greece, from September 1, 1983, through June
14, 2010, were searched to identify puppies and kittens
that underwent surgery for treatment of AA. Animals
that were included in previously published reports or
were euthanized without surgical treatment were ex-
cluded from the study. Those that underwent surgery at
1 of the 2 veterinary teaching hospitals and were either
euthanized within 1 year afterward or had ≥ 1 year of
follow-up after surgery at the veterinary teaching hos-
pital or referring veterinary hospital were included in
the study.
Medical records review—Information collected
from the medical records included signalment, clini-
cal and radiographic findings, number and types of
surgical procedures, follow-up time, and whether fecal
continence was achieved. Follow-up time was mea-
sured from the date of the initial surgery to the date
of last contact with the veterinary teaching hospital or
referring veterinary hospital. On the basis of physical
examination, radiographic imaging, and surgical find-
ings, a classification scheme similar to that previously
described8 was retrospectively applied to all cases ac-
JAVMA, Vol 240, No. 2, January 15, 2012 Scientific Reports 187
cording to the severity of the anomaly: type I = anal
SMALL ANIMALS
stenosis without imperforate anus; type II = imperforate
anus with termination of the rectum in close proxim-
ity (< 1 cm) to the closed anus; type III = imperforate
anus with the rectum terminating in a blind pouch
≥ 1.0 cm beneath the perineal skin; and type IV = ap-
parently normal development of the anus and caudal
rectum with the cranial aspect of the rectum terminat-
ing in a blind pouch. Distances between the closed anus
or perineal skin and the blind end of the rectal pouch
were estimated from radiographs and confirmed via
digital radiographic measurement or by use of a ruler
at the time of surgery.
Diagnosis—Initial diagnosis of AA was made on
the basis of results of physical examination and history
of tenesmus and or perivulvar soiling. Under sedation
or anesthesia (at the discretion of the attending clini-
cian), a ball-tipped probe was used to gently explore
the anus and determine whether it was imperforate.
In females, a probe was also gently inserted into the
vulva and passed into the vagina to confirm a commu-
nication with the rectum. Abdominal radiography was
performed to include lateral and ventrodorsal projec-
tions of the caudal abdomen with the pelvis elevated
to evaluate the degree of colonic dilation, caudal ex-
tent of the rectum, and any sacrococcygeal deformities.
Contrast vaginography with diatrizoate meglumine or
iohexol was performed under general anesthesia in fe-
males unless evidence of RVF (eg, fecal matter excreted
through the vulva) was detected during physical ex-
amination. Radiographic data included still images in
some patients and fluoroscopic examination recordings
in others. All radiographic studies were evaluated by
board-certified radiologists.
Surgical procedures—Surgical repair of AA was
performed in all cases via a perineal approach under
general anesthesia. Animals that underwent anoplasty
and RVF closure alone were placed in ventral recum-
bency; those that underwent anoplasty and colotomy
for removal of impacted feces were placed in dorsal
recumbency.
In animals with type I AA, the stenotic anal orifice
was explored with a ball-tipped probe to determine the
length of the narrowed region. In animals with type II
or greater AA, the anal region was carefully examined
to locate the anal dimple and ducts of the anal sacs
and, if present, these were used as landmarks for ano-
plasty. In females with concomitant RVF, the tip of a
sterile curved mosquito hemostat was carefully placed
through the vulva and into the rectum and was pal-
pated as a landmark for the skin incision. In animals
without RVF or in those without the other described
landmarks, the external anal sphincter, when present,
was typically located prior to anesthesia by applying a
noxious stimulus such as a pinch with a mosquito he-
mostat or pricking with a sterile hypodermic needle to
initiate a contractile response of the sphincter.
In situ anoplasty was initiated by making a vertical
elliptical incision around the anal dimple and medial to
the ducts of the anal sacs, if present. When these struc-
tures were not detected, the skin incision was made in
the center of the anal sphincter. Size of the incision varied
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 according to the size of the patient but generally was 3
SMALL ANIMALS
to 5 mm wide and 8 to 10 mm long. The resulting skin
plug was placed under slight traction and was gently dis-
sected away from the underlying tissue. In animals with
type II or greater AA, a stay suture was placed in the blind
rectal pouch through the surgical opening after skin plug
removal. Anoplasty was continued with tenotomy scissors
under 2X or 3X ocular magnification to carefully dissect
around the rectum in a cranial direction. The anal sacs
were preserved if present. Attempts were made to perform
dissection medial to the external anal sphincter muscle
and to preserve as much of the muscle as possible.
As dissection continued cranially, the RVF was
located, if present. The fistula was carefully dissected
away from surrounding tissues, ligated flush with the
rectal and vaginal walls, and transected. In some ani-
mals, ligatures of 3-0 polydioxanone suture were used.
In others that had more cranially located RVFs, hemo-
static clips were used to occlude the fistula prior to
transection. None of the surgeries included oversewing
of rectal wall to facilitate closure of the RVF. Dissection
was then continued cranially up to a point where the
diameter of the rectum was subjectively considered to
be adequate for normal defecation, and the blind end
was excised. Apposition of the mucosa and submucosa
of the rectal opening to the skin of the anus was com-
pleted with 4-0 or 5-0 monofilament polypropylene su-
ture or 5-0 poliglecaprone 25 in a simple interrupted
pattern. In larger puppies, subcutaneous sutures were
placed prior to the placement of skin sutures.
Reconstructive surgery in 1 case of type III AA with
concomitant RVF and ectopic anus was performed by
maintaining the fistula to reconstruct the anal canal and
anus.19 The RVF was isolated via a 15-mm midline peri-
neal episiotomy incision and passed through a separate
anal incision (created as described for anoplasty). The
mucosal lining of the fistula was sutured to the anal
skin to reconstruct the anus with simple interrupted
sutures as described. The episiotomy incision was then
closed in 2 layers; the vestibular wall was closed with
5-0 poliglecaprone 25 in a simple continuous pattern
and the skin was closed with 5-0 monofilament poly-
propylene suture in a simple interrupted pattern.
Revision anoplasty, when required, was performed
under general anesthesia, typically with the patient in
ventral recumbency. A 10-mm circular incision was
made around the stenotic anus with a No. 15 Bard-
Parker blade. Skin, scar tissue, and rectal mucosa tissue
were removed via dissection with tenotomy scissors in
a cranial direction. Apposition of mucosa to the skin
was performed with 4-0 or 5-0 monofilament polypro-
pylene suture or 5-0 poliglecaprone 25 in a simple in-
terrupted pattern. Animals that underwent concurrent
colotomy were placed in dorsal recumbency, and a mid-
line celiotomy was made from the umbilicus to the pu-
bis. The colon was exteriorized and isolated with sterile
laparotomy sponges, and a 2-cm incision was made in
the descending colon. All fecal material was evacuated
from the colon, and the colotomy incision was closed
with 4-0 polydioxanone suture in a continuous Cush-
ing pattern. Gloves were changed, and the abdomen
was lavaged with sterile saline (0.9% NaCl) solution
and closed routinely.
188 Scientific Reports JAVMA, Vol 240, No. 2, January 15, 2012
Postoperative analgesia was dependent on estab-
lished protocols during the times that surgeries were
performed; however, opioids (eg, butorphanol, bu-
prenorphine, fentanyl, hydromorphone, or morphine)
were prescribed after surgery for all patients at the dis-
cretion of the attending clinician. All animals received
opioid analgesics for 5 to 7 days after surgery. Cisapride
(0.5 mg/kg, PO, q 12 h) and lactulose (0.5 mL/kg, PO,
q 12 h) were administered until normal defecation re-
sumed (typically 2 to 4 weeks). Antimicrobials were
administered at the discretion of the clinician. In addi-
tion, soapy water enemas were administered to animals
in the hospital and by clients at home if needed.
Balloon dilation of strictures—Anal stricture sec-
ondary to irritation or wound dehiscence from loose fe-
ces or repeated enema administration in some patients
was treated with balloon dilation of the stricture prior to
revision anoplasty. Balloon dilation was performed un-
der general anesthesia by use of a commercially available
catheter-mounted silicone balloon system.a The 2.5-mm-
diameter catheter was inserted through the stricture, and
the anus was dilated via inflation of cuffs with increasing
diameters (8, 10, and 12 mm) sequentially.
Follow-up evaluations—Postoperative and follow-
up examinations were performed by the authors or by
referring veterinarians. Anal tone was assessed via rec-
tal examination. Long-term outcome (≥ 1 year) with
respect to continence and tenesmus was recorded in the
medical record. Owners were also contacted via tele-
phone and asked to indicate whether they were satis-
fied with the final outcome and whether they would
have the procedure performed on a pet again.
Results
Selection of cases—Twenty-three animals (19
puppies and 4 kittens) were evaluated for AA at the 2
veterinary teaching hospitals during the study period.
Three of 4 kittens examined had other severe anomalies
including agenesis of the tail, spina bifida, subarach-
noid cyst, and rear limb paresis and were euthanized at
the time of evaluation. Eight puppies either were eutha-
nized or were not returned to the veterinary teaching
hospital for surgery after evaluation. In total, 12 ani-
mals, including 10 puppies and 1 kitten treated at the
University of Florida Veterinary Medical Center and 1
puppy treated at the Companion Animal Hospital of Ar-
istotle University, met the inclusion criteria. One puppy
with type III AA had undergone anoplasty at a referring
veterinary hospital and was referred for assessment of
a postoperative anal stricture and tenesmus. No cases
were lost to follow-up in the first year after surgery.
Animals—Signalment, classification of AA, radio-
graphic findings, surgery, follow-up time, and degree of
continence were assessed in all animals. There were 3
male puppies, 8 female puppies, and 1 female kitten
included in the study. Ten of 11 puppies were purebred,
and 5 of these were of brachycephalic breeds, including
2 Boston Terriers and 1 each of French Bulldog, Boxer,
and Pug. Other dog breeds included Jack Russell Ter-
rier, Miniature Poodle, Rhodesian Ridgeback, Chow
Chow, Rottweiler cross, and Poodle–Shih Tzu cross (1
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each); the kitten was a domestic longhair. Age at evalu- Common short-term postoperative complications
ation ranged from 10 days to 16 weeks. Mean age of included tenesmus, dychezia, fecal retention, and stric-

SMALL ANIMALS
females at the time of surgery was 8.3 weeks (median, ture at the anoplasty site attributed to the small size
7 weeks) and that of males was 6.8 weeks (median, 3 of the patient or to repeated enema administration. All
weeks). Weights of puppies ranged from 0.61 kg (1.34 patients had some degree of tenesmus detectable for 2
lb; a 10-day-old Boxer) to 3.0 kg (6.60 lb; an 11-week- to 5 weeks after surgery.
old Chow Chow), and the kitten weighed 0.71 kg (1.56 Balloon dilation was performed in 6 puppies. In 1
lb). puppy with type I AA, the procedure was performed
as initial treatment for anal stenosis without success
Diagnosis—Findings on physical examination in- and in situ anoplasty was performed 1 month later. In 3
cluded tenesmus, perineal swelling, abdominal disten- puppies with type II AA and 2 with type III AA, it was
tion, hematochezia, anal stenosis (in type 1 anomalies),
imperforate anus (in type II and III anomalies), and
perivulvar fecal soiling in females with concurrent RVF.
All animals had a dilated colon detectable via plain film
radiography prior to treatment, and all were classified
as having moderate to severe megacolon in radiology
reports. Concomitant anogenital or rectogenital malfor-
mations were present in 9 of 12 animals, and 1 puppy
had an ectopic anus. One male Boston Terrier had mild
hypospadius that did not require surgical treatment and
a membrane-like frenulum that was incised at the time
of anoplasty. Seven female puppies and the kitten had
concomitant RVF diagnosed via contrast vaginography
or during surgery (Figure 1). One female Boston Terrier
did not undergo vaginography but had a visible anovul-
var cleft on physical examination that did not require
surgical correction. Thus, all 9 females with AA had
concomitant RVF or anogenital anomalies. Figure 1—Right lateral fluoroscopic view of a 12-week-old do-
Three puppies had type I AA, 5 puppies and the mestic longhair kitten with type II AA and an RVF. Image was
kitten had type II AA, and 3 puppies had type III AA obtained after intravaginal administration of contrast medium (io-
classified on the basis of results of physical examina- hexol). Note the flow of the contrast from the vagina to the rec-
tum denoting the rectovaginal communication (arrowheads). The
tion, radiography, and assessment during surgery. No blind end of the rectal pouch is in close proximity to the closed
type IV anomalies were represented. Puppies with type anus, directly beneath the perineal skin.
I AA comprised 1 male and 2 females (1
with RVF). Four of 5 puppies with type
II AA were females, and 1 was male; all
females in this category including the
kitten had RVFs. Three puppies (1 male
and 2 females) had type III AA (Figure
2). Both females with type III AA had
RVFs and also had agenesis of the tail.
Surgical procedures and postopera-
tive complications—Eleven animals un-
derwent in situ anoplasty with surgical
closure of the RVF when present (7/10
puppies and 1 kitten). The remaining
puppy, a female Rottweiler cross, had
type III AA with an ectopic anus; recon-
structive surgery in this patient was per-
formed by transection and relocation of
the caudoventral aspect of the RVF. Ini-
tial corrective surgery for all animals was
performed at 1 of the 2 veterinary teach-
ing hospitals with the exception of 1
puppy that had undergone anoplasty at a
referring veterinary hospital. This puppy
was evaluated at the University of Flori-
da Veterinary Medical Center for a post-
operative stricture and tensemus, and
assessment of preoperative radiographs Figure 2—Right lateral radiographic view of a 7-week-old female French Bulldog with
from the referring hospital revealed ab- type III AA and agenesis of the tail. The distance between the blind rectal pouch and
normalities consistent with type III AA. the perineal skin was measured as 1.5 cm (double-headed arrow).

JAVMA, Vol 240, No. 2, January 15, 2012 Scientific Reports 189

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 used to treat postoperative anal strictures. One puppy
SMALL ANIMALS
with type III AA developed peritonitis after balloon di-
lation at the stenotic anoplasty site and was euthanized
3 days after the procedure because of poor prognosis.
Balloon dilation was only successful in the puppy that
underwent reconstructive surgery for type III AA and
ectopic anus with the RVF. In this puppy, 2 balloon di-
lations 2 weeks apart had good results with improved
clinical signs.
Of 6 puppies that developed anal strictures, 5 (1
male and 4 females) required revision anoplasty, which
was performed 7 days to 5 weeks after the initial sur-
gery. Continued tenesmus secondary to anal stenosis
and continued retention of feces were the reasons for
revision anoplasty in those cases. Three puppies (1
male and 2 females) also had colotomy to remove im-
pacted feces at the time of revision anoplasty, all with
good results. One of these 5 surgeries, performed in a
French Bulldog with type III AA, had a poor outcome.
This puppy had unresolved colonic distension, severe
tenesmus, and anal stricture attributed to excessive ten-
sion on the suture line and was euthanized 40 days after
the initial surgery.
Long-term outcomes—Follow-up times for 10 of
12 animals ranged from 12 to 92 months after surgery
(mean, 38.4 months [median, 35 months]). Follow-up
times for the 9 animals with type I or type II AA ranged
from 17 to 92 months (mean, 41.3 months [median, 36
months]). Follow-up times for the puppies with type
III AA ranged from 3 days to 12 months (mean, 4.5
months [median, 1.3 months]). Two of 3 puppies were
euthanized (one at 3 days after surgery because perito-
nitis had developed and the other at 40 days after revi-
sion anoplasty because clinical signs failed to resolve).
The remaining dog with type III AA was doing well 12
months after surgery.
Seven of the 10 surviving animals had fecal conti-
nence at the time of the last reported physical examina-
tion, although anal tone was assessed as weak (ie, sub-
jectively less than normal) on rectal examination. Daily
fecal incontinence was reported in 2 dogs. One of these
had been treated for type I AA and the other for type II
AA. One other dog that had rare intermittent inconti-
nence associated with excitement had been treated for
type I AA. The owners of dogs with fecal incontinence
indicated that this was not a hindrance to ownership
of their dogs. Nine of 10 animals reportedly appeared
comfortable during defecation, but 1 had residual mild
tenesmus. Six of the surviving animals were fed com-
mercially available over-the-counter diets, and 4 were
fed prescription low-residue diets. Owners of the sur-
viving animals all indicated they were pleased that the
procedures had been performed.
Discussion
In the retrospective case series described here, 11
puppies and 1 kitten underwent surgical correction of
AA. This anatomic anomaly was retrospectively classi-
fied in all patients according to a previously described
veterinary classification scheme.8 Classifications were
determined on the basis of results of physical exami-
nation and plain and contrast radiography as well as
190 Scientific Reports JAVMA, Vol 240, No. 2, January 15, 2012
findings during surgery. Identification of animals with
type I AA was uncomplicated because a probe could be
carefully inserted through the anus for a variable dis-
tance and any meconium or fecal material present was
attenuated in diameter. Differentiation between type
II and type III AA was more difficult because animals
with both types of the defect had an imperforate anus.
Those classified as having type II AA had a detectable
anal dimple and inducible anal contraction reflex; anal
sacs and ducts were also present in addition to the im-
perforate anus. In all animals with type II AA, the blind
end of the rectal pouch was < 1 cm of the imperforate
anus, typically directly below the perineal skin. Con-
versely, all animals with type III AA had agenesis of the
anal sacs and reduced or questionable anal reflex, and
the blind end of the rectal pouch was ≥ 1 cm from the
imperforate anus. Two of the 3 animals with type III AA
were females with concomitant RVF, and both of these
had agenesis of the tail. No animals in the present study
had type IV AA.
The retrospective case series reported here is simi-
lar to other reports8,18 in that purebred dogs, including
the Boston Terrier breed, were represented (2/11 pup-
pies) and that females (9/12 animals) were more com-
monly affected than were males. All females described
in this report had concomitant anogenital or rectogeni-
tal anomalies, including 7 of 8 female puppies with
RVFs and 1 with an anovulvar cleft. This is also similar
to a case series17,20 in which 5 of 5 affected dogs had
RFVs. Of 3 male puppies in the present study, 1 had
mild hypospadias that did not require surgical correc-
tion. Although urethrorectal fistulas have been reported
in cats10 (including 1 male with AA21) and dogs,22 no
animals in the present study had urethrorectal fistu-
las. Anovaginal cleft and hypospadius have commonly
been described in Boston Terriers,23 and this finding in
puppies in the present study underscored the need to
carefully evaluate all animals with AA for additional
urogenital or anogenital anomalies. The kitten in the
present study was similar to those described in another
case series9 in which all affected cats were females with
concomitant RVFs.
All animals in the study reported here were initial-
ly examined for abdominal distension and tenesmus,
with hematochezia in some puppies that had type 1
AA. Most animals also had perineal swelling evident
on physical examination. Some puppies had RVFs of
sufficient diameter to allow effective excretion of feces
through the vulva.
All animals had continued tenesmus and signs of
pain during defecation for the first 2 to 5 weeks after
surgery. The degree of discomfort and tenesmus seemed
to be worse if colonic atony was severe or a large amount
of fecal material had to be evacuated through the ano-
plasty site after surgery. Stricture of the anoplasty site
developed in 6 of 12 patients after surgery, including the
puppy in which the RVF was used for anal reconstruc-
tion. Postoperative stricture is a common complication
reported by others and may be attributable to small
patient size, passage of enema catheters, fecal soiling,
local infection, and wound dehiscence.8,9,18 When anal
stricture did develop in patients in the present study,
balloon dilation was performed; however, this method
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was only successful in 1 of 6 cases. Failure of balloon
dilation to correct strictures in these patients was simi-
lar to that described in other reports.8,9
Revision anoplasty was performed in 5 puppies in
which anal stricture, tenesmus, and fecal retention de-
veloped or persisted after the initial surgery. The second
surgery was successful in treatment of anal stricture in
4 of these 5 patients. In 3 puppies, colotomy was per-
formed to evacuate feces at the time of revision surgery.
To the authors’ knowledge, colotomy has not previously
been reported as an adjunctive procedure in the surgi-
cal treatment of AA in dogs but a temporary end-on co-
lostomy has been used in 1 cat.11 Several reports8,18 have
also described the use of subtotal colectomy for treat-
ment of unresolved colonic dilation after surgery for
AA. However, subtotal colectomy was not performed in
any patients in the present study because of concern
that permanent softening of feces could negatively af-
fect fecal continence, as reported in another case series.8
Although the colotomy was performed during revision
anoplasty in the present study and only a small num-
ber of puppies had this procedure performed, the good
results led us to believe that in some animals, it might
be beneficial if performed at the time of anoplasty if
severe megacolon is present. On the basis of improved
clinical signs, it was assumed that megacolon improved
after correction of the AA; because not all puppies had
postoperative radiography performed, this could not
be verified. However, lactulose and cisapride were ad-
ministered for only 2 to 4 weeks in these patients and
seemed to be unnecessary after that time.
In the study reported here, all 9 animals with type
I and type II AA survived for ≥ 1 year after surgery;
6 of these 9 had fecal continence and 1 had intermit-
tent incontinence. Conversely, 2 of 3 puppies with type
III AA had complications or clinical signs after surgery
and were euthanized at 3 and 40 days after surgery. The
puppy that was euthanized at 3 days was a 3-week-old
male Rhodesian Ridgeback that underwent anoplasty at
the referring veterinary hospital and had developed an
anal stricture prior to admission to the University of
Florida Veterinary Medical Center. Stenosis in this pup-
py was treated by means of balloon dilation with the
intent that a revision anoplasty could be performed at a
later time, but peritonitis developed as a result of appar-
ent rectal tearing and the puppy was euthanized. The
other puppy that had a poor outcome was a 7-week-old
female French Bulldog with a concomitant RVF as well
as lack of an anal reflex and agenesis of the tail. Revi-
sion anoplasty was performed 30 days after the initial
surgery to treat tenesmus and anal stricture, but this
failed to resolve the clinical signs and the animal was
euthanized 40 days after initial surgery.
The only patient with type III AA that had a success-
ful outcome was a 4-week-old female Rottweiler cross.
This puppy had an RVF, an ectopic anus, and agenesis
of the tail and underwent surgical reconstruction in
which the RVF was used for anal reconstruction. This
technique was first described for use in a cat in 199010
and was used successfully in a dog in 2003.18 The pro-
cedure was later modified to be performed through an
episiotomy incision in 2 dogs.19 Reconstruction with
the RVF has been advocated because some investiga-
JAVMA, Vol 240, No. 2, January 15, 2012 Scientific Reports 191
tors believe that portions of the internal anal sphincter
SMALL ANIMALS
are preserved within the rectovaginal communication
in humans and that use of this tissue may also reduce
tension along the suture line.18,19 Anal reconstruction
by use of the RVF has resulted in satisfactory outcomes
in reported cases18,19 but has the limitation of not be-
ing applicable to males. Because rectal swelling also
occurs during estrus in female dogs, concomitant or
subsequent neutering of females is necessary with this
technique.19 In the 1 puppy described in the present
report that underwent this procedure, it was ultimate-
ly successful; however, balloon dilation was performed
twice because of stenosis within the fistula. Thus, a
congenitally narrow fistula might also be a hindrance
to the successful use of this technique. In animals with
type I or II AA, clinical results of in situ anoplasty were
considered to be good in the present study and in an-
other study,18 although revision anoplasty was needed
in some cases. Therefore, preservation of the fistula for
reconstruction may not be necessary in animals with
type I or II AA.
Additional studies will be needed to determine
which surgical techniques are optimal for reconstruc-
tive anoplasty in puppies and kittens with AA. How-
ever, on the basis of results of the study reported here,
the type I to IV classification scheme for AA may be
useful in determining the type of surgical procedure
that is best suited for a particular patient. Although
preoperative diagnosis included traditional radio-
graphic methods in cases evaluated for the present
study, ultrasonography, computed tomography, or
magnetic resonance imaging may also be of benefit in
the evaluation and anatomic typing of AA in small ani-
mals, considering that these techniques are currently
being used in human medicine.24,25
a. Microvasive Rigiflator, Boston Scientific, Natick, Mass.
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Graw-Hill Medical, 2010;121.

From this month’s AJVR

Morphometric features of the craniocervical junction region

in dogs with suspected Chiari-like malformation determined
by combined use of magnetic resonance imaging
and computed tomography
January 2012
Dominic J. Marino et al

Objective—To objectively describe morphometric features of the craniocervical junction region of See the midmonth issues
Cavalier King Charles Spaniels (CKCSs) and non-CKCS dogs with suspected Chiari-like malformation
(CLM) and identify associations between these features and the presence of other malformations of JAVMA
in this region.
for the expanded table of
Animals—216 CKCSs and 58 non-CKCS dogs.
Procedures—Magnetic resonance and computed tomographic images of the head and craniocervi- contents
cal junction region of patients evaluated because of suspected CLM were assessed for cerebellar for the AJVR
compression (CC), ventral spinal cord compression at the C1-C2 articulation (medullary kinking), and
dorsal spinal cord compression at the C1-C2 articulation (dorsal compression). A compression index or log on to
was calculated for each of these 3 locations in each dog. Multiple logistic regression analysis was
performed to determine whether breed (CKCS vs non-CKCS) and compression index values were avmajournals.avma.org
associated with the presence of other craniocervical junction abnormalities. for access
Results—All 274 dogs had CC; medullary kinking was identified in 187 (68.2%) and dorsal compres-
sion was identified in 104 (38.0%). Atlantooccipital overlapping (AOO) was identified in 76 (27.7%) to all the abstracts.
dogs. Breed of dog (CKCS vs non-CKCS) and value of CC index were the only significant predictors of
AOO. The CKCSs had an almost 5-fold decrease in risk of AOO, compared with the non-CKCS dogs,
and the risk of AOO nearly doubled for every 10% increase in CC index.
Conclusions and Clinical Relevance—The anatomic abnormality responsible for CC was AOO in
a substantial percentage of dogs suspected to have CLM. The CC index value may be used to help dif-
ferentiate subtypes of craniocervical junction abnormalities in dogs. (Am J Vet Res 2012;73:105–111)

192 Scientific Reports JAVMA, Vol 240, No. 2, January 15, 2012

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