Splenectomy

This is the case of a 14 year old, male, neutered West Highland White Terrier who presented in emergency on a Sunday after he collapsed at home. Only 4 days before he had been seen by his vet after an episode of seizure, and he was currently on anti-epileptic drugs (Epiphen) twice a day, and on  tramadol and gabapentin for his arthritis, also twice a day.

On arrival, the dog was tachycardic, his mucous membranes were very pale, and his capillary refill time very prolonged, all signs of shock. Apart from that, his breathing was heavy, body temperature was slight low, his abdominal palpation was uncomfortable, although he did not seem to be bloated, and he was unable to stand up yet. He was immediately admitted to start on aggressive fluid therapy to counteract the shock. It was hard to place an intravenous catheter, but we finally managed to get one into his vein and start the therapy.

As soon as he was more stable a full blood test was performed, which show marked anaemia and proteinemina, dehydration, and a mild renal failure. Due to the history of collapse, his signs of shock and the anaemia with proteinemia, our first concern was ruling out some internal bleeding. With a simple abdominal ultrasound scanning, or AFAST we could see some pockets of free fluid in the abdomen, consistent with blood, and a mass in his spleen.

Because of his old age and his already limited mobility, a long discussion followed with his owner, in which it was discussed the likelihood of success, the need to find out if the mass was benignant or malignant, the post-op care, and his quality of live. 

Finally it was decided to do a thoracic radiography to rule out any metastasis in the lungs, and another one in the abdomen to assess other possible complications. The chest radiography was unremarkable, and on the abdominal one we could clearly see the mass sit in his tummy.

The owner decided to go ahead with the surgery, in which the spleen was removed and the mass was sent to a pathologist for a biopsy. As we suspected, the blood in his abdomen was coming from the splenic mass after it ruptured. A couple of days later he was discharge, much happier than he arrived. 

We are still waiting for the results, either a splenic haematoma (benignant) or a hemangiosarcoma (malignant) to plan post-op chemotherapy and make a prognosis.