Bodie's Blog: Episode One. The Case of the Angry Spleen

Dr.Bodie has graciously decided to help us write some blogs.  Here is the first installment of what's I like to call "Bodie's Blog".

IF YOU THINK YOUR PET HAS SPLENIC TORSION, PLEASE CONTACT US OR YOUR REGULAR VETERINARIAN IMMEDIATELY. SPLENIC TORSION OR OTHER PROBLEMS INVOLVING THE SPLEEN ARE LIFE THREATENING PROBLEMS THAT HAVE TO BE SEEN BY A VETERINARIAN IMMEDIATELY.

Background

In twenty five years, I have had the honor to care for and help well over ten thousand dogs, I can remember most if not all of them, but some dogs really stand out in my mind. “Mr G.” was one of them.

"Mr.G" is a dog with a canine black belt. Mr G is a beautiful one hundred twenty pound Alsatian Shepard. Mr G (his name has been changed to protect the innocent) never complains, so when he came in one Saturday morning in a lot of pain, I took notice. One day, Mr. G came in with a life threatening emergency. What doctors call a splenic torsion. That's when the spleen twists on itself and becomes engorged with blood. In a life threatening emergency, you have to do a hundred things right in a very short period of time. No room for any mistakes, no second chances, no "do-overs", no mulligans. Treating life threatening emergencies is not for the faint of heart. One of the first things I learned when dealing with such an emergency, no matter how crazy everything is, with people crying, the one person in the room that has to stay calm is the doctor. Easier said than done. Even "McDreamy" gets more than one take. Mr G, watched my every move. Rather unnerving. One hundred pounds of pure taunt muscle with over thirty teeth and two steely eyes watching my every move. Mr G didn't have to say, "don't mess up doc", he was the strong silent type. After many hours of surgery, after most of the exhausted staff had gone home, it was just me and Mr G. I remember flushing out his I.V. Catheter to prevent it from forming a dangerous blood clot, thinking Mr G was still knocked out. Wrong. I was inches from his face when he woke up, not in the best of moods. The day before, Mr G didn't have a care in the world. Twenty fours later, his life was in my hands. All Mr G knew was that his belly hurt more than anything else in the world, he had just woken up from an incredibly long surgery and even after getting painkillers, he still had to be hurting. So what did Mr G do? Bite my face? No, he gently took my hand in his mouth to politely let me know he had had enough. What a cool dog. The black belt that wouldn't hurt a fly, or good thing for me, a vet. I stayed with Mr G almost the whole night; it was the least I could do. Even weeks later, he was the same stoic rock. Endless rechecks, endless injections and he never complained. The best lessons in life are lessons learned from example and dogs set the bar rather high. In my opinion, it is a lesson for the rest of us to learn. Mr G was just happy to be alive. In his words, enough said.

Splenic torsion occurs when the spleen twists around the abundant blood vessels that go to the spleen. The problem occurs in that the arteries are high blood pressure, but the veins are low blood pressure

which means that the arteries are able to deliver blood to the twisted spleen but the venous return has been occluded. With every heartbeat, the spleen grows larger and larger. Like most visceral organs the spleen doesn’t have a lot of pain fibers in the spleen itself, but has abundant pain fibers in the capsule resulting in tremendous pain for the patient when the blood engorged spleen enlarges.. IF YOU THINK YOUR PET HAS SPLENIC TORSION, PLEASE CONTACT US OR YOUR REGULAR VETERINARIAN IMMEDIATELY. SPLENIC TORSION OR OTHER PROBLEMS INVOLVING THE SPLEEN ARE LIFE THREATENING PROBLEMS THAT HAVE TO BE SEEN BY A VETERINARIAN IMMEDIATELY. TIME IS CRITICAL AND OFTEN EMERGENCY SURGERY IS REQUIRED. WITH PROMPT TREATMENT, A PATIENT WITH A SPLENIC TORSION CAN BE SAVED. IN ADDITION, THE CLINICAL SIGNS OF SPLENIC TORSION ARE SIMILAR TO GASTRIC DILATATION VOLVULUS ALSO KNOWN AS BLOAT. BLOAT IS ANOTHER LIFE THREATENING EMERGENCY WHERE SECONDS COUNT. IF YOU THINK YOUR PET HAS EITHER OF THESE PROBLEMS, PLEASE CONTACT US OR YOUR REGULAR VETERINARIAN IMMEDIATELY.

Clinical signs

Patients with splenic torsion present in acute often severe abdominal discomfort or pain. In most cases, abdominal distention is noted. Physical exam finding include evidence of hypovolemic shock (rapid heart rate, rapid respiratory rate, depression, weak pulses, cool extremities, abdominal distension and pain. Radiographs are immediately taken and the engorged spleen can be seen on the radiograph (XRAY): 

Emergency treatment:

After placing an intravenous catheter, a blood transfusion is done because of the large amount of blood trapped or sequestered in the spleen: 

Many thanks to “Buster” aka “Buss Buss”, who is one of my technician’s dogs, for being a universal donor and such a good sport. The deal was that I had to buy Buster a steak dinner.

A large abdominal incision is made and the engorged spleen is exposed

Very carefully as not to rupture the engorged spleen, the spleen is removed from the abdominal cavity:

The spleen is then removed from the patient. All critical patients require constant monitoring and observation is a critical care setting:


One of several monitors used to insure a critical patient’s safety. These numbers didn’t mean much to Mr G, but they did to me, the percent of oxygen saturation is 100% and the pulse rate is 124. Perfect!

Finally, the enlarged spleen is out of the body and a full recovery, like in the case of Mr G is expected.

© 2012 Neil Bodie DVM, member VECCS ALL RIGHTS RESERVED.

To Your Pets Good Health!
Brittany
Temple City Animal Hospital
626-287-1173
5406 N. Rosemead Blvd.
San Gabriel CA
www.templecityanimalhospital.com