For some reason that no-one can seem to decipher, cases in the emergency room seem to come in runs. Over the past few weeks at the Animal Emergency Service we have had a lot of animals come through our doors that have had problems with their spleen and needed to have them removed.
For pet owners the thought of removing any organ from their animal is of course a scary thing. Here is a little information about the spleen and the problems that can be associated with it to hopefully help our owners in their understanding of what it is, the problems that can be associated with it and how their pet can live without it.
The spleen is an oblong shaped organ that sits in the top part of the abdomen just below the stomach. The function of the spleen is as a support organ. It acts as a part of our immune system filtering the blood, trapping old cells, bacteria and foreign proteins. The older red blood cells in our circulation are recycled here and it is the only site outside the bone marrow where new ones can be made. It also acts as a reservoir for our blood as the body has the ability to contract the spleen in times of stress so that additional red blood cells can be released into the bloodstream. The other cells in our blood, the platelets and white blood cells, are also stored within it.
While this seems to be a very important function in our bodies, humans and our canine/feline friends, can live perfectly healthy lives without a spleen. The other organs in the body can perform these functions and once recovered they can go back to leading a normal healthy life.
When does it become a surgical emergency?
The two most common presentations we see in emergency that result in the need to remove the spleen immediately are splenic torsions/rotations and bleeding masses causing a haemabdomen.
Splenic torsions occur most commonly in larger breed dogs and can either happen with the spleen alone or in combination with an air filled stomach as gastric dilation-volvulus. A torsion of the spleen or the spleen/stomach is a surgical emergency.
The most common cause of a bleeding spleen (other than trauma) is due to a splenic mass or tumour. The most common form of splenic tumour is a haemangiosarcoma. They are most often seen in middle aged to senior dogs and especially in larger breeds such as the labradors. Unfortunately it is a nasty disease and carries a very poor prognosis, especially when they have already bled into the abdomen. There are a few other types of malignant cancers that affect the spleen but 70% of malignant tumours are haemagiosarcomas.
We can also see benign tumours of the spleen called haemagiomas. While this type of tumour does not spread and carries a much better prognosis, they can still be life threatening if they start to bleed into the abdomen and cause large amounts of blood loss.
How do we diagnose a splenic tumour and how do we know if it is malignant or not?
The best way to diagnose an abdominal bleed and its origin is via abdominal ultrasound. On ultrasound the presence of fluid within the abdominal cavity can be confirmed, a sample taken by abdomenocentesis (needle inserted into the abdomen) and we can have a good look at the spleen and ascertain if there are any abnormalities and if it is likely the cause of the bleed.
Once the spleen has been confirmed as the likely cause of the bleed the case becomes a surgical emergency. The only way to ensure the bleeding stops and to diagnose what type of tumour is present is to preform an exploratory laparotomy and remove the bleeding organ. The spleen is then sent off to the lab for investigation and a diagnosis can be made as to the cause of the tumour/bleed.
What to expect after surgery.
A splenectomy is a major abdominal surgery and you can expect that your pet will need intensive monitoring for several days after surgery to ensure there are no signs of heart abnormalities, infection or bleeding disorders. This also ensures the best pain management and control of nausea or other possible causes of discomfort post operatively. Unfortunately prognosis is extremely variable after a splenectomy if a malignant tumour was removed, however surgery can be curative if a benign disease or torsion is present.