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com
Companion animal practice

Investigation and management

of splenic disease in dogs

Graham Hayes and Jane Ladlow

Splenic disorders are a significant cause of morbidity and mortality in middle-

Graham Hayes graduated from
the University of Cambridge in
2001 and worked at the RSPCA
Greater Manchester Animal
Hospital for seven years. He
currently works in private practice
in Cheshire. He holds the RCVS
certificate in small animal surgery
and is a diplomate of the European
College of Veterinary Surgery.
aged and older dogs, and a spectrum of presentations is possible, from chronic
non-specific clinical signs to a rapidly fatal haemoabdomen. Splenomegaly is
commonly recognised during clinical examination or imaging in practice, but
it can be difficult to decide whether the primary problem is within the spleen
itself (eg, a focal mass, in which case a splenectomy is generally the treatment
of choice) or whether the splenomegaly represents systemic disease (eg, a
lymphoma or immune-mediated haemolytic anaemia, in which case a biopsy
may be useful but a splenectomy may be contraindicated). Splenic surgery
requires an appreciation of the vascular anatomy, and adequate monitoring
as well as supportive treatment may be critical to the outcome of surgery.
This article discusses the anatomy of the spleen and how to investigate
splenomegaly, as well as how to perform a (partial) splenectomy and the
possible complications involved.

Anatomy Short gastric vessels

Jane Ladlow graduated from the
in the gastrosplenic
ligament
The spleen is a mobile, parenchymal organ that is
normally located in the left cranial quadrant of the Stomach
abdomen and partially covered by the costal arch. It
is attached to the greater curvature of the stomach by
the gastrosplenic ligament and loosely suspended by Left gastroepiploic vessels

University of Cambridge in 1995
and has worked in general practice
and at the Animal Health Trust.
She is currently a lecturer in soft
tissue surgery at Cambridge and
is a diplomate of the European
College of Veterinary Surgeons.
doi:10.1136/inp.e3107
Provenance: Commissioned
and peer-reviewed
the greater omentum. The actual position of its ven-
tral extremity varies depending on stomach size and
degree of engorgement. The spleen is supplied by the Splenic
splenic artery (from the celiac artery), which splits into artery
about 25 branches before entering the hilus on the vis- Pancreas
ceral surface (Fig 1). It is drained by the gastrosplenic Splenic
branches
vein, which contributes to the hepatic portal vein. The entering
blood supply to the spleen is closely associated with the hilus
the gastroepiploic vessels of the stomach and vessels Branches to the
supplying the left lobe of the pancreas. greater omentum and
splenocolic ligament

Box 1: Functional anatomy of the spleen
The spleen is part of the reticuloendothelial system and has many important functions,
but is not essential for life. The following two functions are associated with the
anatomically distinct parenchymal areas of the organ:
■■ ‘White pulp’ – lymphoid tissue involved in immunosurveillance and the production of
B and T lymphocytes. The white pulp of the spleen functions as a large lymph node;
■■ ‘Red pulp’ – venous sinuses containing macrophages, megakaryocytes and white
blood cells. The red pulp performs erythrocyte conditioning and maintenance,
erythrocyte and platelet storage, and extramedullary haematopoiesis. The splenic
reservoir can contain up to 20 per cent of erythrocytes and 30 per cent of platelets
in a dog, and these can be mobilised by sympathetic contraction of the smooth
muscle in the capsule and internal trabeculae.
In humans, a partial splenectomy is performed in preference to a complete
splenectomy as the latter has occasionally been associated with fatal septicaemias.
This complication has not been reported in dogs or cats, so a complete splenectomy
is routinely performed in these animals.
Fig 1: Schematic diagram showing the vascular
anatomy of the canine spleen
Pathophysiology
The multiple functions of the spleen (Box 1) help to
explain some of the pathological conditions that affect
this organ. The large amount of lymphoid tissue present
means reactive hyperplasia or lymphoproliferative
disease may cause diffuse splenic enlargement or focal
nodular hyperplasia. Extramedullary haematopoiesis
may also be associated with diffuse splenomegaly in
consumptive anaemias or bone marrow disease; a
splenectomy in such cases would be disadvantageous
and potentially detrimental to the patient.

250 In Practice  May 2012 | Volume 34 | 250–259

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The large amounts of connective tissue and vascular
sinuses present in the spleen make it a frequent loca-
tion to find primary sarcomas as well as secondary neo-
plasms. In addition, the compliant vascular spaces make
the organ susceptible to haematoma formation and vas-
cular congestion, which may be drug-induced and sec-
ondary to portal hypertension, right-sided heart failure
or torsion of the vascular pedicle (which may or may not
be associated with gastric dilation/volvulus [GDV]).
Diverse clinical signs associated with a space-
occupying abdominal mass, blood dyscrasia, para-
neoplastic syndromes or hypovolaemic shock with a
haemoabdomen may result from splenic disease.
Clinical signs
The clinical signs of splenic disease are highly variable
and may be non-specific or have an insidious onset.
Subtle signs, such as a reduced appetite, weight loss,
intermittent vomiting, lethargy, depression, abdomi-
nal distension, polydipsia and polyuria, may be noted
by the owner. Other findings on clinical examin­
ation may include pyrexia, pale mucous membranes,
abdominal distension, palpable splenomegaly and
pain on abdominal palpation. Generalised lymph­
adenopathy may be present with lymphoproliferative
diseases. Splenic congestion may be associated with
right-sided heart failure or portal hypertension. Signs
of an acutely distended, painful abdomen, coupled
with pale mucous membranes and tachycardia, may
occur with the rupture of a splenic mass or a traumatic
splenic rupture. A splenic haemangiosarcoma may also
be associated with signs of ventricular arrhythmias or
coagulopathy (petechiae or ecchymoses).
Investigation
Splenomegaly is the primary differential diagnosis for
a mid-abdominal mass but further imaging is usually
indicated to confirm the problem (Box 2).
Biochemistry and haematology
Although biochemistry and haematology testing may not
indicate specific changes with splenic diseases, they are
recommended to rule out other differential diagnoses
and to obtain baseline values for haematocrit and total
protein. Hypercalcaemia may be suggestive of lympho-
proliferative disease and hyperglobulinaemia can also be
associated with lymphoproliferative disease and chronic
infections such as ehrlichiosis and leishmaniosis.
If anaemia or other cytopenias are apparent on hae-
matology, examination of a blood smear is indicated to
confirm and further characterise the changes. Anaemia
may be due to chronic disease (mild to moderate non-
regenerative), bone marrow disorders or consump-
tion in haemolytic anaemia (eg, immune-mediated
haemolytic anaemia [IMHA], babesiosis or lympho-
proliferative disease). Spherocytes and schistocytes
may be present in IMHA and haemangiosarcomas,
respectively. Haemolysis and diffuse splenomegaly
can be associated with splenic torsion, which may
resemble IMHA. Thrombocytopenia may be associ-
ated with sepsis, lymphoproliferative disease, immune-
Companion animal practice
Box 2: Differential diagnoses of splenomegaly
Diffuse splenomegaly disease, obstruction of the caudal
■■ Infiltrative vena cava)
●● Neoplastic (eg, leukaemia, ●● Drug-induced (especially
lymphoma, systemic mastocytosis, barbiturates)
multiple myeloma, malignant
histiocytosis) Focal splenomegaly
●● Non-neoplastic (eg, extramedullary ■■ Primary or secondary neoplasia
haematopoiesis, hypereosinophilic ●● Haemangiosarcoma, haemangioma,
syndrome) other sarcomas*
■■ Infectious ■■ Non-neoplastic
●● Bacterial (eg, septicaemia, bacterial ●● Nodular lymphoid hyperplasia*
endocarditis) ●● Haematoma
●● Viral (eg, canine adenovirus type 1) ●● Abscess
●● Parasitic (eg, haemobartonellosis, ●● Hydatid cysts
ehrlichiosis, leishmaniosis, babesiosis) ●● Granuloma
■■ Hyperplastic ●● Fibrohistiocytic nodules*
●● Immune-mediated haemolytic
anaemia or immune-mediated *A continuous spectrum of disease is
thrombocytopenia recognised ranging from nodular lymphoid
●● Primary or secondary hypersplenism hyperplasia through fibrohistiocytic
■■ Congestive nodules to malignant fibrous histiocytoma.
●● Splenic torsion (eg, primary or This represents the progression of
secondary to gastric dilation/volvulus) histopathological features from benign
●● Portal hypertension (eg, right-sided inflammatory disease to high-grade
congested heart failure, hepatic malignancy (Spangler and Kass 1998).
mediated disease and ehrlichiosis. Clotting profiles (or
a buccal mucosa bleeding time) should be considered
when haemoabdomen, haemangiosarcoma or blood
dyscrasia is present.
Ultrasonography
The assessment of splenic size is subjective (Box 3) and
radiography is generally insensitive for distinguishing
between generalised splenomegaly and a focal mass.
Ultrasonography is usually considered most useful
for imaging the spleen as it allows focal masses to be
defined and allows the parenchyma and capsule to be
evaluated, even in the presence of abdominal fluid (Fig
2). It is useful for guiding fine-needle aspirations and
evaluating other abdominal organs, and is especially
sensitive to changes in the splenic architecture (eg,
due to neoplastic infiltration or infarction). Vascular
changes can be assessed using colour Doppler ultra-
sonography. When a focal cavitary mass is detected,
ultrasonographic assessment of the heart (particularly
Box 3: Normal variations in the size
of a canine spleen
■■ Young, athletic dogs generally have larger spleens
than older dogs
■■ German shepherd dogs have relatively larger
spleens than other breeds
■■ Barbiturates and certain tranquillisers cause
marked splenic congestion. However, Wilson
and others (2004) found that an anaesthetic
protocol comprising acepromazine plus an
opiate premedication followed by propofol
induction caused significantly less engorgement
than protocols using medetomidine, diazepam,
ketamine or thiopentone
■■ Excitement and sympathetic catecholamines
cause splenic contraction
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Companion animal practice
Fig 2: Ultrasonographic image of a large nodule on the
parietal surface of the splenic body. Ultrasonography
allows the splenic parenchyma to be imaged
accurately, even in the presence of abdominal fluid
the right atrium and auricle) and thoracic radiography
are indicated, given the behaviour of one of the main
differential diagnoses (ie, haemangiosarcoma).
Doppler ultrasonography is particularly useful for
examining flow in the splenic vein in cases of suspected
torsion (Fig 3) or thrombosis, but has not been shown to
distinguish between benign and malignant focal disease
(ie, haematoma and haemangiosarcoma) in the spleen
reliably. Microbubble contrast-enhanced ultrasonogra-
phy has shown slightly improved results at distinguish-
ing between neoplastic and benign lesions (Rossi and
others 2008), but cytological or, most often, histopatho-
logical evaluation tends to be necessary to enable this
distinction.
Biopsies
A fine-needle aspiration biopsy is a relatively low-risk
procedure that can be performed using ultrasound
guidance to investigate hyperechoic foci within the
parenchyma. Cytology is sensitive for the diagnosis of
round cell tumours and extramedullary haematopoiesis
but less sensitive for connective tissue tumours, which
tend to exfoliate cells poorly. Consequently, cytology
is unlikely to distinguish between a haematoma and
haemangiosarcoma for a focal mass lesion, but may be
diagnostic for a splenic lymphoma (Fig 4) or mast cell
tumour metastasis (Fig 5). Preoperative cytology has
been reported to agree with post­operative histopathol-
ogy in about 60 per cent of cases (Ballegeer and others
2007).
A small risk of haemorrhage or neoplastic seeding
along needle tracts is inherent with needle aspiration
techniques and aspiration is relatively contraindicated
in animals with cavitary lesions due to the risk of haem-
Fig 4: Gross capsular changes in a canine spleen
diffusely infiltrated by lymphoma (Picture, Prue Neath)
252 In Practice  May 2012 | Volume 34 | 250–259
Fig 3: Doppler ultrasonography showing vascular stasis
in the splenic vasculature of a dog with splenic torsion
orrhage. Percutaneous biopsy of the spleen is less
frequently performed due to the risk of severe haem-
orrhage. Surgical or laparoscopic biopsy is safer and
yields superior samples if a histopathological diag-
nosis is required before a splenectomy is performed.
Surgical biopsy may be performed using a Tru-cut
needle, an overlapping mattress suture technique or a
skin biopsy punch, with an almost identical technique
to that routinely used to sample the liver. Topical hae-
mostatic agents (eg, Surgifoam; Johnson & Johnson)
may be beneficial for haemostasis.
Splenectomy
Indications for a splenectomy include focal mass
lesions and torsion. Initially, a standard ventral midline
celiotomy is performed and the abdomen is explored.
Self-retaining retractors (eg, Balfour retractors) and
excision of the falciform fat may improve exposure of
the abdominal viscera. In the presence of gross haemo-
abdomen, it may not be possible to explore the abdo-
men properly until a splenectomy has been performed.
The spleen should be exteriorised and packed off with
damp laparotomy swabs.
Total splenectomy
There are two acceptable methods for a total splenec-
tomy. One involves ligation of the individual splenic
vessels as they branch to enter the hilus, working
Fig 5: Metastatic mast cell tumours can be diagnosed
by ultrasound-guided fine-needle aspiration of
suspicious hyperechoic foci in the splenic parenchyma
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Companion animal practice
Box 4: Automatic stapling
This auto suture powered ligating dividing stapler (LDS;
Tyco Healthcare) contains 15 pairs of titanium staples
and is designed for ligating small vessels and pedicles.
The cartridge jaw is placed around the pedicle and the
device activated by squeezing the handle. Two staples are
automatically placed 9·5 mm apart on the pedicle, which
Auto suture powered ligating dividing stapler (LDS)
(above) and its use during a splenectomy (right)
from the tail to the head of the spleen. The main branch-
es of the splenic artery and vein are double-ligated and
transfixed in larger dogs. A variety of suture materi-
als can be used for these ligations, including vicryl,
poly­dioxanone suture material and metal haemostatic
clips. Use of an automatic stapling device (Box 4) or
a vessel-sealing device (Covidien) minimises surgical
time.
A faster technique involves ligating the splenic
artery and vein within the omental bursa, followed
by the vessels at the head and tail of the spleen. This
method reduces surgical time and the amount of
suture material used but is not without risk. The
branches of the splenic artery supplying the left limb of
the pancreas must be identified and preserved to pre-
vent pancreatic ischaemia, but these vessels can be dif-
ficult to locate in a ‘fatty’ omentum, so this technique
is not recommended unless the surgeon is confident
with the regional anatomy.
Splenic surgery is aided by surgical suction; it is
impossible to ensure adequate haemostasis has been
achieved and to perform a thorough metastasis check
if blood remains in the abdomen. In some cases of
traumatic or non-neoplastic haemoabdomen, it may
be possible to autotransfuse anticoagulated blood
through a microaggregate filter, but it is not recom-
mended to leave blood in the abdomen.
Following a splenectomy, biopsies or aspirates
can be taken from the abdominal lymph nodes if indi-
cated, and any suspicious organ (eg, hepatic) lesions
can be biopsied. If possible, all hepatic lobes should be
visually examined and palpated for lesions. Hepatic
nodular hyperplasia is common in older dogs, so the
presence of hepatic nodules does not always indicate
metastases. Ligatures on the splenic pedicle should be
rechecked before routine abdominal closure.
Histopathology is essential following a splenectomy
as it is impossible to distinguish different pathologies on
gross examination. Ideally, the whole spleen should be
submitted for analysis, but if this is not possible it should
be sliced (like a loaf of bread) and several sections sub-
mitted. The remainder of the organ should be kept in
case unexpected or inconclusive results are obtained.
254 In Practice  May 2012 | Volume 34 | 250–259
is then divided between the staples by a small blade.
Although the device is expensive (about £125), this cost
is offset by reduced surgical time and the amount of
suture material used. Use of such a device should be
considered when surgical time must be minimised in
an unstable patient.
Partial splenectomy
A partial splenectomy may be an option if there are
focal benign lesions or traumatic lacerations near the
head or tail of the spleen, but is not recommended
in cases of malignant disease. The hilar vessels sup-
plying the part of the spleen to be removed should
be ligated and divided. Atraumatic Doyen forceps
are placed either side of the transaction line and the
spleen divided between these forceps. The cut surface
of the spleen is then oversewn with a simple continuous
pattern to appose the cut edges of the capsule. For
larger spleens, overlapping mattress sutures can be
placed through the parenchyma adjacent to the forceps
to ensure ligation of larger vessels. A thoracoabdomi-
nal stapler can be used to reduce the overall surgical
time.
Possible complications
Postoperative haemorrhage
Postoperative haemorrhage may occur due to inad-
equate intraoperative haemostasis, which may be
exacerbated by bleeding disorders. Postoperative
packed cell volume (PCV) and total protein, heart
and respiratory rates, pulse quality, capillary refill
time (CRT) and mucous membrane colour should
be monitored routinely after surgery. Post­operative
bleeding can be confirmed using ultrasonography
and measuring the PCV of fluid collected by
abdomino­centesis.
If the bleeding is acute and severe with signs of
hypovolaemic shock (eg, tachycardia, tachypnoea, pale
mucous membranes and delayed CRT), further surgery
is indicated to locate and ligate the source of the bleed.
If coagulation disorders are suspected, prothrombin
time, partial prothrombin time and platelet counts
should be obtained (if possible). If indicated, red blood
cells and clotting factors can be supplemented using
fresh whole blood, fresh plasma, fresh frozen plasma
and/or cryoprecipitate.
Ventricular arrhythmias
Ventricular arrhythmias are common after emer-
gency splenic surgery and may occur up to 72 hours
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Companion animal practice

postoperatively. Although most intermittent
arrhythmias will be self-limiting, lidocaine infu-
sions are commonly used in some hospitals both for
analgesia and arrhythmia prophylaxis in high-risk
patients. Occasional ventricular premature contrac-
tions do not require treatment and are usually self-
limiting, but indications for treatment include ven-
tricular tachycardia (>180 beats per minute) or
haemodynamically significant arrhythmias affecting
perfusion (eg, pulse deficits, poor peripheral pulses
and CRT).
Reduced vascular reservoir function
Splenectomised laboratory dogs have been shown to
have a reduced ability to compensate for acute hypovol-
aemic insults and have decreased platelet reserves, and
are therefore used as models of haemorrhagic shock.
Reduced capacity for extramedullary
haematopoiesis
Splenic haematopoiesis may be significant in some
haemolytic anaemias and bone marrow disorders.
A splenectomy could be fatal in patients that are
dependent on extramedullary haematopoiesis, and is
contraindicated in most anaemias.
Increased risk of GDV
A splenectomy could theoretically increase the risk
of gastric rotation, so prophylactic gastro­pexy could
be considered at the time of a splenectomy in high-

Box 5: Case example

A 10-year-old female entire labrador retriever was
presented following two episodes of collapse in
the previous week from which it had recovered
spontaneously.
On examination, the animal was pale and tachycardic
(heart rate 116 beats per minute) but had a normal capillary
refill time (CRT) (less than two seconds). Splenomegaly
was suspected based on abdominal palpation.
Haematology, biochemistry and urinalysis were
performed. Both the biochemistry and urinalysis were
unremarkable except for mild elevations in hepatic
enzymes (alanine aminotransferase 61 iu/litre [reference
range 21 to 59 iu/litre] and alkaline phosphatase
238 iu/litre [reference range 3 to 142 iu/litre]) and
isosthenuria (specific gravity 1·009). The haematology Female labrador at presentation
report is shown in Table 1.
Ultrasonographic imaging of the abdomen was fluid had a packed cell volume (PCV) of 0·30 and
performed and revealed a large cavitated mass within was consistent with a diagnosis of haemoabdomen
the mid-body of the spleen and a mass adjacent to the secondary to a ruptured splenic mass.
spleen in the omentum. A large amount of free fluid The dog was placed on intravenous fluids and its
was present in the abdomen and sampled through blood pressure was monitored until surgery could be
abdominocentesis under ultrasound guidance. This performed. Bilateral chest radiographs, clotting profiles
and blood typing were also undertaken and the results
are given in Table 2.
Table 1: Haematology results
The dog was premedicated with methadone,
Parameter Result* induced with propofol and maintained on isoflurane
White blood cells 29·8 (6·0-17·0) x 109/litre during surgery. Several additional boluses of fentanyl
were given during anaesthesia. Initially, intravenous
Neutrophils 25·9 (3·0-11·5) x 109/litre
crystalloid solution was given at 5 ml/kg/hour. Pulse
Lymphocytes 1·2 (1·0-4·8) x 109/litre oximetry, capnography, electrocardiogram, temperature
Eosinophils 0 (0·1-1·3) x 109/litre and Doppler blood pressure were monitored under
anaesthesia. To maintain the animal’s blood pressure,
Basophils 0 (0-0·5) x 109/litre
the fluid rate was increased to 10 ml/kg/hour and a
Red blood cells 3·7 (5·5-8·5) x 1012/litre 2 ml/kg bolus of hetastarch was given on two occasions
Haemoglobin 78 (120-180) g/litre during surgery.
The abdomen was prepared for surgery. A ventral
Haematocrit 0·23 (0·37-0·55) litre/litre midline coeliotomy was performed and Balfour
Mean corpuscular volume 61 (60-77) fl
Mean corpuscular 20·9 (19·5-24·5) pg Table 2: Clotting profiles and
haemoglobin blood typing results
Mean corpuscular 340 (320-370) g/litre Parameter Result*
haemoglobin concentration
One-stage 10·6 (7·6-11·6) seconds
Red blood cell distribution 18·1 (13·2-17·8) per cent prothrombin time
width
Activated partial 12·8 (12·5-25·0) seconds
Platelets 164 (175-500) x 109/litre thromboplastin time
Reticulocytes (absolute value) 184 x 109/litre Platelets 205 (175-500) x 109/litre
Reticulocytes 4·9 (0-1·0) per cent Blood group Dog erythrocyte antigen 1:1
negative
*Reference ranges are given in brackets
Note: absolute neutrophilia and monocytosis, red blood *Reference ranges are given in brackets
cell anisocytosis and polychromasia ++, platelets consistent Note: platelet count, prothrombin time and
with count, anaemia is slightly regenerative partial prothrombin time are within normal limits

256 In Practice  May 2012 | Volume 34 | 250–259

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risk large and giant breeds. However, Goldhammer
and others (2010) reported no association between
a splenectomy and an increased subsequent risk of
GDV and gastropexy is not routinely performed by the
authors.
Pancreatitis
The splenic artery is the principal supply to the
left limb of the pancreas and proximal ligation of
the splenic vascular pedicle can cause ischaemic
pancreatitis. It is safer to perform a splenec­
tomy by ligation of the splenic vessels closer to the
hilus. Ligation of the short gastric vessels in the gas-
trosplenic ligament may reduce the vascular supply
to part of the greater curvature; however, the col-
Ultrasonographic image showing an irregular
focal splenic lesion with omental adhesions
Haemoabdomen confirmed on entry into the
abdominal cavity
retractors were used to improve exposure of the
abdomen viscera. A Poole suction tip was used to
remove fluid from the abdomen and the spleen was
isolated and packed off with moist laparotomy swabs.
The anatomy of the spleen was distorted by the focal
mass and omental adhesions. A large blood clot was
present within the omentum adjacent to the ruptured
mass, as had been indicated by ultrasonography.
The splenic artery was double-ligated early to
prevent further blood loss while the splenectomy
was being performed.
After the splenectomy and removal of large
blood clots from the abdomen, the abdominal viscera
was routinely examined and palpated but no gross
metastatic lesions were evident. A total of 750 ml
of fluid was suctioned from the abdomen, and the
abdomen was copiously lavaged with several litres of
sterile saline to remove all blood clots. The splenectomy
site was checked for bleeding before routine closure.
Companion animal practice
lateral supply to the stomach makes this clinically
insignificant.
Increased risk of septicaemia
Humans undergoing splenectomy have a 5 per cent
lifetime risk of overwhelming postsplenectomy infec-
tion due a septicaemia or meningitis caused by encap-
sulated bacteria (eg, Streptococcus pneumoniae). This is
thought to occur due to the loss of splenic macrophages
and a reduced ability to remove opsonised bacteria
from the bloodstream. Hence, a partial splenectomy
is performed in preference to a complete splenectomy
in humans. Asplenic humans receive additional vaccin­
ations against encapsulated bacterial pathogens, anti­
biotic prophylaxis for wounds and dental treatment and
Right lateral abdominal radiograph showing an
abdominal effusion and splenomegaly. The splenic
capsule has an irregular outline
Large haematoma found in the omentum adherent
to the splenic mass. This was confirmed to be a
haemangiosarcoma by histopathology
After surgery, the PCV was rechecked (0·21) and
the dog was closely monitored for 36 hours, with vital
parameters (heart and respiratory rates, systolic blood
pressure, peripheral pulse quality, mucous membrane
colour and CRT) being recorded every two hours for the
first 12 hours. Potential complications considered were
abdominal haemorrhage, disseminated intravascular
coagulation, ventricular arrhythmias, sepsis and acute
renal failure. Blood products were available if signs
of ongoing haemorrhage or coagulopathy became
apparent.
The animal’s subsequent recovery was uneventful. The
PCV and total protein were rechecked the next morning
and the dog was discharged two days after surgery.
A haemangiosarcoma was confirmed by
histopathology. The owners declined further
chemotherapy and the dog was euthanased
approximately 11 weeks after the splenectomy,
with signs suggestive of metastatic disease.
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Companion animal practice
Fig 6: Focal splenic lesion that was confirmed
as a benign haematoma. (Picture, Prue Neath)
are at a higher risk of tropical vectorborne diseases (eg,
malaria). These risks have not been reported in dogs,
but it is thought that canine babesia infections may be
more serious in asplenic animals.
Specific splenic conditions
Siderotic plaques (iron and calcium deposits) and some
fibrinous material are normal changes and must not
be confused with pathology. Small deposits of splenic
parenchyma in the omentum (‘splenosis’) can also be
an incidental finding and must not be confused with
metastases. Splenosis is thought to arise from traumatic
rupture of the spleen and the subsequent grafting of
fragments onto the omentum.
Neoplasia
Splenic neoplasia is relatively common in dogs and is the
most frequent indication for a splenectomy. However, it
is impossible to differentiate between benign and malig-
nant lesions grossly and patients should not be eutha-
nased due to the presence of a focal, solitary splenic
lesion without a diagnosis. About 50 per cent of splenic
submissions to pathology laboratories demonstrate
benign changes (eg, haema­toma [Fig 6] and nodular
hyperplasia) and the remaining 50 per cent are malig-
nancies. About 25 per cent of dogs presenting with non-
traumatic haemoabdomen have a benign haematoma
rather than a malignancy (Hammond and Pesillo-Crosby
2008, Aronsohn and others 2009). Haemangiosarcomas
account for up to 80 per cent of malignancies, with the
remainder comprising lymphomas, mast cell tumours,
leiomyosarcomas, fibrosarcomas, osteosarcomas and
malignant fibrous histiocytomas (Spangler and Kass
1997). Splenic tumours are most frequently seen in
older large-breed dogs, with German shepherd dogs
and labrador retrievers over-represented (Prymak and
Fig 7: (a) Engorged spleen of a
weimaraner presenting with
a splenic torsion. (b) Torsed
vascular pedicle of the same
spleen. (Pictures, Laura Owen) A B
258 In Practice  May 2012 | Volume 34 | 250–259
others 1988). A haemangiosarcoma is highly malignant
and overt metastasis has been reported in up to 80 per
cent of patients at presentation; it may coexist in both
the spleen and right atria in up to 25 per cent of dogs
(Walters and others 1988).
Dogs with a concurrent right atrial haemangio­
sarcoma may present with signs of acute right-sided
heart failure due to pericardial effusion. All types of
haemangiosarcoma can be associated with cardiac
arrhythmias, disseminated intravascular coagulation
(DIC) or sudden death.
The prognosis for a confirmed haemangiosarcoma
is poor, with median survival times of three to 12
weeks after surgery alone. Doxorubicin chemotherapy
(four doses, three weeks apart) can be used to palli-
ate metastases and attempt to improve the survival
time to four to six months; however, the one-year sur-
vival is less than 8 per cent (MacEwen 2001). Novel
treatments, such as the use of angiogenesis inhibitors,
tumour vaccines and intracavitary chemotherapy, have
been reported, with mixed results.
The prognosis for a splenic haematoma is better
than for a haemangiosarcoma, with over 80 per cent
of dogs surviving the postoperative period and two-
thirds surviving at least one year (Prymak and others
1988). However, this lower than expected survival rate
for a benign lesion may reflect undiagnosed systemic
disease or may represent histological misdiagnosis
from the submission of inadequate tissue samples.
Torsion
Splenic torsion may be a primary condition or may occur
secondarily to GDV; it is most commonly reported in
large deep-chested breeds (similar to GDV). A variety
of presentations is possible, from an acute abdomen and
circulatory shock to a chronic, grumbling condition with
non-specific signs of intermittent abdominal pain, vom-
iting, anorexia, abdominal distension and polydipsia/
polyuria (Neath and others 1997). The chronic disease
is frequently accompanied by anaemia, thrombocyto­
penia and leucocytosis due to inflammation and seques-
tration within the spleen. Liver enzymes are frequently
elevated, presumably due to systemic inflammation or
circulatory compromise. Haemoglobinuria is common
due to haemolysis and patients may develop cardiac
arrhythmias or progress to DIC.
Abdominal imaging will identify an enlarged spleen,
possibly with an abdominal effusion. Ultrasonography
 Downloaded from inpractice.bmj.com on February 23, 2014 - Published by group.bmj.com
Box 6: Splenic disease in cats
Splenic lesions appear to be less common in cats than
dogs, with most lesions causing diffuse rather than
focal enlargement. A large survey of feline splenic
submissions showed the most common malignancies
to be visceral mast cell tumour (15 per cent),
lymphoma (9 per cent), myeloproliferative disease
(6 per cent) and haemangiosarcoma (3 per cent),
although a high proportion of submitted spleens
were considered ‘normal’ (15 per cent) or ‘congested’
(9 per cent) (Spangler and Culbertson 1992).
Although a splenectomy is indicated for the
management of focal haemangiosarcoma and is
useful as an adjunctive treatment for feline visceral
mastocytosis, the treatment of myeloproliferative
diseases and lymphoma by chemotherapy may be
delayed by surgical splenectomy. Hence, ultrasound-
guided fine-needle aspiration may be a better course
of action unless focal gross pathology is present.
is useful for imaging the hypoechoic parenchyma and
Doppler ultrasonography of the hilus and vascular
pedicle by skilled operators is both specific and sensi-
tive for diagnosing torsion or thromboembolism.
Following appropriate stabilisation, the treatment
of choice is a splenectomy, taking care not to untwist
the vascular pedicle, although successful derotation
of a splenic torsion has been reported (Goldsmid and
others 1994). The vascular pedicle should be gradually
divided and ligated and care must be taken to ligate the
splenic artery distal to the pancreatic branch (Fig 7).
If torsion or necrosis of the left lobe of the pan-
creas is also present, a partial pancreatectomy should
be performed.
Trauma
Splenic laceration resulting from a penetrating injury
and splenic rupture due to blunt abdominal trauma are
probably underdiagnosed as the injury is either unrec-
ognised and self-limiting or rapidly fatal. The preva-
lence of healed splenic fractures and implanted splenic
fragments (splenosis) as incidental findings during
exploratory celiotomies suggests that blunt trauma is
underdiagnosed. Iatrogenic splenic injuries may occur
during abdominocentesis, ultrasound-guided biopsy
of abdominal organs, sharp incision through the linea
alba and percutaneous gastrostomy tube placement.
Haemoabdomen following trauma must be care-
fully managed, using intravenous fluids, abdominal
compression bandaging or appropriate blood prod-
ucts, and monitored (ie, cardiovascular status includ-
ing blood pressure and serial monitoring of PCV
and total protein). An approach termed ‘hypotensive
resuscitation’ should be adopted, in which the need to
support the circulation is balanced without exacerbat-
ing bleeding, similar to that for patients with pulmo-
nary contusions. Failure to stabilise with supportive
treatment or excessive abdominal haemorrhage is an
obvious indication for an emergency celiotomy.
Surgical options for treating splenic trauma include
the use of topical haemostatic agents (eg, Surgifoam),
primary surgical repair and a partial or complete
splenectomy. Temporary occlusion of the splenic artery
(by an assistant, a Rummel tourniquet or vascular
clamps) can be performed to facilitate surgery.
Companion animal practice
References
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ARMBRUST, L. (2009) The spleen. In BSAVA Manual
of Canine and Feline Abdominal Imaging. Eds R.
O’Brien and F. Barr. BSAVA Publications. pp 167-176
MISON, M. & NILES, J. D. (2005) The spleen.
In BSAVA Manual of Canine and Feline Abdominal
Surgery. Eds J. M. Williams and J. D. Niles. BSAVA
Publications. pp 220-233
In Practice  May 2012 | Volume 34 | 250–259 259
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Investigation and management of splenic

disease in dogs
Graham Hayes and Jane Ladlow

In Practice 2012 34: 250-259

doi: 10.1136/inp.e3107

Updated information and services can be found at:

http://inpractice.bmj.com/content/34/5/250.full.html

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References This article cites 13 articles, 2 of which can be accessed free at:
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