Laparoscopic Splenectomy in Goats

Objective— To report laparoscopic splenectomy in goats.
Study Design— Experimental study.
Animals— Healthy female goats (n=9); aged, 10–18 months; weighing, 22–30 kg.
Methods— Food was withheld for 24 hours and water for 10 hours. Anesthetized right laterally recumbent goats had a laparoscopic portal and 3 instrumental portals created in the left flank. Splenic attachments were dissected with monopolar electrocautery and blunt dissection through 2 instrument portals. Exposure and isolation of splenic vessels was performed with laparoscopic "right-angle" preparation forceps. Vessels were ligated with a medium-titanium clip and 2 silk sutures and then transected between the silk sutures. The detached spleen was manipulated into a specimen retrieval bag, morcellated, and the bag retrieved through an enlarged portal. Repeat laparoscopic examination was performed at 1 month.
Results— Laparoscopic splenectomy required 70 minutes (range, 52–88 minutes) and was successful without major intraoperative and postoperative complications. Postoperatively, all goats had signs of mild abdominal discomfort. On repeat laparoscopy, with the exception of 1 goat that had a focal omental adhesion to the enlarged portal site, no other abnormalities were identified.
Conclusions— Laparoscopic splenectomy can be accomplished in goats using 4 portals in the left flank and a combination of monopolar cautery dissection of splenic attachments, ligation of vessels using metal clips and intracorporeal ligatures, and intra-abdominal morcellation of the detached spleen in a specimen retrieval bag.
Clinical Relevance— Laparoscopic splenectomy is an effective and safe technique in goats.     

Resolution of severe thrombocytopenia in two standard Poodles with surgical correction of splenic torsion

Objective: To describe the diagnosis and treatment of 2 cases of severe thrombocytopenia associated with splenic torsion and to discuss the pathophysiologic mechanisms underlying the thrombocytopenia. Summary: We report 2 cases of severe thrombocytopenia associated with splenic torsion. Each dog presented with non‐specific clinical signs, radiographic evidence of an intra‐abdominal mass, and platelet counts of less than 25,000 platelets/μL. The diagnosis of splenic torsion was made with abdominal ultrasonography and was confirmed during exploratory laparotomy. Both dogs recovered rapidly following splenectomy. The cause of thrombocytopenia associated with splenic torsion is not fully elucidated, but may be because of either platelet sequestration within the torsed spleen, platelet consumption in disseminated intravascular coagulation, or a combination of both. New information provided: This report provides previously unreported evidence that the degree of thrombocytopenia associated with splenic torsion may be of a severity at which primary hemostasis is compromised, and resolution of thrombocytopenia occurs after splenectomy.     

Use of a vessel sealant device for splenectomy in dogs

Objective: To (1) describe a technique for splenic vessel hemostasis and (2) report complications and outcome after use of bipolar sealant device during splenectomy in dogs. Study Design: Case series. Animals: Dogs (n=27) with naturally occurring splenic disease. Methods: Between January 2006 and March 2008, splenectomy was performed using a vessel sealant device in 27 dogs with naturally occurring splenic disease. Number of sutures needed for splenectomy and complications were recorded. Splenic artery diameter was measured using a caliper. Intraoperative hemostasis, device ease of use, postoperative hemorrhage, and short‐term survival were evaluated. Results: Splenectomy was performed successfully in 27 dogs with the vessel sealant device; none of the dogs required vessel ligation with suture. The splenic artery was dissected and adequately sealed in each dog. One dog was readmitted 4 days after surgery with hemoabdomen. Abdominal exploration revealed splenic pedicle hemorrhage and pancreatitis, the vessel sealant device was used to coagulate splenic pedicle bleeding. The dog was alive at suture removal. Conclusion: In dogs, a vessel sealant device may be used to achieve efficient and safe hemostasis of the splenic vascular pedicle without sutures.     

Chronic primary splenic torsion with peritoneal adhesions in a dog: case report and literature review

Primary splenic torsion in dogs is uncommon and can occur in acute or chronic form. The chronic form is difficult to diagnose because the clinical signs are vague and sometimes intermittent. A dog with a history of diaphragmatic hernia repair two years previously presented with chronic, vague clinical signs and an abdominal mass. The mass was revealed to be spleen on ultrasonography. On exploratory laparotomy, the dog was found to have a splenic torsion of approximately 180 degrees with mature, fibrous adhesions retaining the spleen in a torsed position. A splenectomy was performed, and the dog recovered uneventfully with complete resolution of prior clinical signs. Prognosis for dogs with splenic torsion is good, although complications are relatively common.     

Laparoscopic-assisted cystotomy for urolith removal in geldings

OBJECTIVE: To describe a technique for laparoscopic-assisted removal of cystic calculi in geldings and report outcome. STUDY DESIGN: Clinical report. ANIMALS: Four geldings with cystic calculi. METHODS: Laparoscopic-assisted cystotomy and urolith retrieval was performed in 4 anesthetized geldings positioned in dorsal recumbency. With a laparoscope portal located at the umbilicus, the abdomen was insufflated and then the surgical table was tilted (30 degrees head-down position) before an instrumental portal was created parallel and 2-3 cm medial to the left external inguinal ring. Laparoscopic grasping forceps were inserted to grasp the cranial aspect of the bladder and elevate it to the ventral abdominal wall. With the instrumental portal as mid-point, the parainguinal skin incision was longitudinally extended cranial and caudal (approximately 8-10 cm) to accommodate the size of the urolith. The apex of the bladder was exteriorized and sharply incised, the urolith extracted, and after cystotomy closure, the bladder was repositioned. The mini-laparotomy and trocar incisions were closed in layers. RESULTS: There were no intra- or post-operative complications. All horses had minor incisional swelling for 3-4 days. No signs of abdominal or incisional pain were observed. Hematuria and slight stranguria occurred until the 3rd or 4th day. Surgical time (skin incision to skin closure) was 35-40 minutes. On long-term follow-up (up to 12 months) no recurrence of clinical signs associated with cystic calculi occurred. CONCLUSION: Uroliths (6-8 cm diameter) can be removed by laparoscopic-assisted cystotomy in geldings. CLINICAL RELEVANCE: Laparoscopic-assisted cystotomy combines the advantages of the parainguinal laparocystotomy with laparoscopic technique for removal of cystic calculi while avoiding their disadvantages.     

Splenic marginal zone lymphoma in 5 dogs (2001-2008)

Background: Splenic marginal zone lymphomas (MZL) in dogs arise from the marginal zone of B‐cell follicles and can progress slowly. Objectives: To describe clinical features, treatment, and outcome of dogs with splenic MZL. Animals: Five dogs with naturally occurring MZL. Methods: Clinical, laboratory, and follow‐up data were retrospectively reviewed. Diagnosis was based on clinical, histopathological, and immunophenotypic features. Results: All dogs had stage IV disease; among them, 2 were symptomatic (substage “b”) because of splenic rupture. Four dogs underwent splenectomy and adjuvant doxorubicin, and 1 dog underwent surgery only. Three out of the 4 dogs treated with surgery and chemotherapy died of causes unrelated to lymphoma, after 760, 939, and 1,825 days, whereas the remaining dog was alive and in complete remission after 445 days. The dog not receiving any adjuvant treatment had recurrence of the tumor after 180 days. Conclusions and Clinical Importance: Splenic MZL appears indolent and can benefit from splenectomy, with or without systemic chemotherapy.     

Chronic splenic torsion in a dog with an accessory spleen

A 4-year-old, neutered male, mixed breed Old English sheepdog was presented for evaluation and treatment of anorexia, vomiting, and diarrhea. Presumptive severe pancreatitis was diagnosed based on the referral bloodwork. Abdominal ultrasonography identified a suspected liver lobe torsion based on the presence of a normal spleen. However, an exploratory laparotomy identified a splenic torsion in addition to a grossly normal spleen.Key clinical message:This case demonstrates that a second, potentially large area of splenic tissue (ectopic or accessory) can be present in the dog; therefore, the presence of a normal appearing spleen on abdominal ultrasonography does not rule out splenic torsion.     

A wound retraction device for laparoscopic-assisted intestinal surgery in dogs and cats

Objectives: To report experience with laparoscopic‐assisted intestinal resection and anastomosis for treatment of discrete intestinal masses using a novel wound retraction device. Study Design: Case series. Animals: Dogs (n=2) and cats (6). Methods: Dogs and cats with discrete intestinal masses identified by ultrasonography without evidence of intestinal perforation or peritonitis, were included. A 2 portal technique was used; 1 portal was enlarged for insertion of the wound retraction device through which the intestine was examined as thoroughly as possible. The diseased portion of the intestine was exteriorized through the wound retractor and resection and anastomosis of the intestinal mass performed. Results: Of the 8 animals, laparoscopic‐assisted intestinal resection and anastomosis through the wound retractor was performed in 2 dogs and 3 cats. In 3 cats, based on either location or extent of the lesion, 2 were converted to laparoscopic‐assisted intestinal biopsies and 1 to an open colocolostomy. No other intra‐ or perioperative complications were encountered and all animals survived to discharge. Conclusions: Laparoscopic‐assisted intestinal resection and anastomosis can be performed in select canine and feline patients with modestly sized, discrete intestinal masses.     

SURGICAL MANAGEMENT OF PANCREATIC NODULAR HYPERPLASIA BY PARTIAL PANCREATECTOMY IN A BLACK-TAILED PRAIRIE DOG (CYNOMYS LUDOVICIANUS)

A 7.5-year-old male black-tailed prairie dog was presented for diarrhea of 3 weeks’ duration. Clinical examination revealed a multinodular mass in the left cranial quadrant of the abdomen that was confirmed with ultrasound. An exploratory laparotomy was performed and the majority of the mass and adherent spleen were removed. Histological diagnosis was severe pancreatic nodular hyperplasia associated with secondary pancreatitis and passive splenic congestion. The prairie dog recovered without complications. Three weeks following the surgical procedure, follow-up ultrasound showed no evidence of abnormal tissue in the pancreaticoduodenal area. Two months postsurgery, a follow-up computed tomographic scan revealed no significant abnormalities. No recurrence was noted 13 months following the mass removal. This article describes the diagnosis of pancreatic nodular hyperplasia in a prairie dog and successful treatment of complications arising from the condition by partial pancreatectomy.     

Ectopic spleen presenting with anemia and an abdominal mass in a dog

An 11.5-year-old, neutered male, golden retriever dog that had previously had a splenectomy for benign disease 2 years prior to presentation was diagnosed with anemia and a large abdominal mass. Necropsy and histopathology identified the abdominal mass as ectopic splenic tissue.     

A primary extraskeletal osteogenic sarcoma arising in the spleen of a dog

This paper describes a primary extraskeletal osteogenic sarcoma arising in the spleen of an 11-year-old, male, cross-bred Terrier. Initial diagnosis was made after surgical removal of a splenic mass, at which time the liver and other abdominal viscera appeared grossly normal. However, elevations in the activities of alanine aminotransferase and alkaline phosphatase in blood taken 7 days after laparotomy suggested that hepatic metastases were developing. This was confirmed when the dog died 3.5 months after surgery, with massive hepatic metastatic involvement. There appears to be no previous report of the spleen being the primary site of such a neoplasm in the dog.     

Standing Laparoscopic Ovariectomy Technique with Intraabdominal Dissection for Removal of Large Pathologic Ovaries in Mares

Objective: To describe a standing laparoscopic ovariectomy technique with intraabdominal ovarian dissection inside a specimen retrieval bag for removal of large pathologic ovaries through small incisions. Study Design: Case series. Animals: Mares (n=43) aged 2–21 years and weighing 380–680 kg. Methods: Unilateral laparoscopic ovariectomy was performed on 43 standing sedated mares. Ovaries were approached via 3 portal sites, 2 in the paralumbar fossa and a 3rd between the 17th and 18th ribs on the ipsilateral side. Ovaries were dissected free using either a LiNA Tripol‐bipolar laparoscopic forceps or a Ligasure™ Vessel Sealing Device and removed by enlarging the proximal portal site ventrally using a grid technique. Use of a plastic specimen retrieval bag and cannula suction device facilitated intraabdominal dissection of very large ovaries into 2 or more pieces, before removal through small incisions. Results: Regardless of size, all ovaries were removed successfully through small incisions (range, 5–10 cm), with no major complications and an excellent cosmetic result. All sport horses returned to previous levels of work or higher, with 93% of breeding mares successfully bred in the 1st season after surgery. Conclusions: Large pathologic ovaries can be easily and safely removed by standing laparoscopic ovariectomy on the mare. Clinical Relevance: Standing laparoscopic ovariectomy combined with a small flank incision is a safe and highly effective technique for removal of large pathologic ovaries in the mare, negating the requirement for general anesthesia or large incisions.     

Extraction of urethral calculi by transabdominal cystoscopy and urethroscopy in nine dogs

Objectives : To describe a minimally invasive technique for treating urethral obstructions in male dogs and to review the postoperative results. Methods : All dogs (n=9) had urethral obstruction due to calculi. Obstructions were verified by radiographic and ultrasonographic examinations. Dogs with impaired kidney function were not included in the study. A 5‐mm diameter trocar and cannula were placed in the ventral midline, 2 cm cranial to the umbilicus, allowing placement of a 10‐mm diameter cannula under visual guidance, adjacent to the apex of the bladder. The bladder was then partially exteriorised and sutured to the skin. A 5‐mm diameter cystoscopy sheath was introduced into the bladder lumen and advanced into the urethra. Continuous retrograde flushing was used to dislodge the calculi from the site of obstruction and collect them upstream. Results : The nine dogs were followed up for a minimum of 6 months. No major postoperative complications were identified. One dog exhibited transient macroscopic haematuria (for 3 weeks postoperatively). All urethral calculi were removed in the nine dogs. No recurrence was found during the follow‐up period. Clinical Significance : A minimally invasive approach is used to treat urethral obstructions resulting from calculi in the male dogs.     

IMAGING DIAGNOSIS—ECTOPIC SPLEEN MIMICKING HEPATIC TUMOR WITH INTRA‐ABDOMINAL METASTASES INVESTIGATED VIA TRIPLE‐PHASE HELICAL COMPUTED TOMOGRAPHY IN A DOG

A 10‐year‐old castrated male miniature dachshund was presented with an abdominal mass. The dog had a history of splenectomy. Triple‐phase helical computed tomography was utilized, revealing a hepatic mass and multiple intra‐abdominal solid masses. In triple‐phase helical computed tomography the images, hepatic mass and two of four intra‐abdominal masses were heterogenous in all phases. Therefore, we diagnosed a malignant hepatic tumor and presumed intra‐abdominal metastases. The masses were surgically removed and were histologically composed of normal spleen tissues, findings which were consistent with ectopic spleen.     

Splenosis in a dog

A 6-year-old male Rhodesian Ridgeback dog developed splenosis following splenectomy for a rupture of the spleen. The dog did well for 4 years following splenectomy but then developed progressive hepatomegaly, leading to the death of the animal. Grossly the abdomen was filled with masses of tissue arising from the liver. Multiple nodules of various sizes were seen in the remainder of the liver and attached to the mesentery, diaphragm and peritoneal wall. Histologically, the lesions contained splenic tissue consisting of both red and white pulp, and were characterized by all the normal cell elements of the spleen, including erythropoietic tissue. The proportion of red to white pulp was, however, abnormal, and the fibromuscular septae and sheath arteries were not obvious. In the smaller lesions, and in the margins of the large lesions, splenic tissue replaced the hepatic tissue except for the bile ducts. The multiple, intrahepatic nodules indicated splenic vein embolism.     

Ophthalmomyiasis interna anterior in a dog: keratotomy and extraction of a Cuterebra sp. larva

A 1‐year‐old female spayed mixed‐breed dog was presented for evaluation of acute onset of lethargy and blepharospasm OD. Slit‐lamp biomicroscopy revealed a segmented larva embedded in the inferonasal iris. Moderate anterior uveitis was present. After pharmacologic dilation, mild vitreal hemorrhage and chorioretinal migration tracks were identified. The dog was treated empirically for uveitis for 5 days, after which a keratotomy and larval foreign body extraction was performed. The dog recovered uneventfully from intraocular surgery and remained visual and comfortable. Parasite evaluation confirmed the larva to be a Cuterebra sp. To the authors’ knowledge, this is the first report of canine ophthalmomyiasis interna anterior, and the first report of successful surgical removal from the anterior segment in a dog with preservation of vision.     

IMPROVED DETECTION OF METASTATIC HEPATIC HEMANGIOSARCOMA NODULES WITH CONTRAST ULTRASOUND IN THREE DOGS

Three dogs with a splenic hemangiosarcoma were imaged with conventional gray-scale ultrasound and no lesions were identified in the liver. After administration of intravenous ultrasound contrast medium (Definity) small, poorly enhanced, hypoechoic nodules were identified in the liver in each dog. The spleen and liver lesions were identified at surgery and the dogs underwent splenectomy and nodule biopsy. All lesions were identified histologically as hemangiosarcoma. These preliminary results suggest that contrast ultrasound may result in improved detectability of metastatic hepatic hemangiosarcoma.     

Nasal infestation by Linguatula serrata in a dog in the UK: a case report

A two‐year‐old, female neutered, cross‐breed dog imported from Romania was diagnosed with nasal infestation of Linguatula serrata after she sneezed out an adult female. The dog was presented with mucopurulent/sanguinous nasal discharge, marked left‐sided exophthalmia, conjunctival hyperaemia and chemosis. Computed tomography and left frontal sinusotomy revealed no further evidence of adult parasites. In addition, there was no evidence of egg shedding in the nasal secretions or faeces. Clinical signs resolved within 48 hours of sinusotomy, and with systemic broad‐spectrum antibiotics and non‐steroidal anti‐inflammatory drugs. Recommendations are given in this report regarding the management and follow‐up of this important zoonotic disease.     

Video‐Assisted Thoracoscopic Resection of Noninvasive Thymomas Using One‐Lung Ventilation in Two Dogs

Objective— To report the technique and outcome of video‐assisted thoracoscopic surgery (VATS) for resection of cranial mediastinal thymoma in 2 dogs. Study Design— Case report. Animals— Eleven‐year‐old Labrador Retrievers (n=2). Methods— Two dogs had VATS resection of thymoma. Preoperative computed tomography (CT) scans revealed well‐circumscribed cranial mediastinal masses with dimensions of 4.5 cm × 4.2 cm × 3.7 cm and 2.1 cm × 2.1 cm × 4.1 cm (at the time of resection) without CT evidence of vascular invasion. One‐lung ventilation (OLV) was achieved using a bronchoscopically placed double‐lumen endobronchial tube. A 3‐portal technique was used for VATS access to the thorax. Thymomas were dissected from the tissues of the cranial mediastinum with the aid of a harmonic scalpel and retrieved in specimen retrieval bags. Results— Two cranial mediastinal thymomas were resected successfully, with their capsules intact, using a VATS technique. One dog developed aspiration pneumonia postoperatively which resolved with treatment and remains healthy 18 months postoperatively with no radiographic evidence of tumor recurrence. The second dog was diagnosed with myasthenia gravis, megaesophagus, and aspiration pneumonia preoperatively and despite recovering well from the procedure had a second episode of aspiration pneumonia 5 days postoperatively and was euthanatized. Conclusions— VATS resection of modestly sized noninvasive thymoma is possible in dogs. Careful case selection and preoperative imaging are the keys. Clinical Relevance— Thoracoscopic resection of modestly sized mediastinal masses forms part of an increasingly expansive set of indications for minimally invasive surgery in select veterinary patients.