Splenectomy

What is the spleen and what does it do?

The spleen is an organ of the hematopoietic (blood) and lymphatic (immune) system. The spleen is located near the stomach. Its main job is to store, distribute and remove old red blood cells in the body and react to infections (bacteria, viruses, parasites) of the red and white cells of the blood. Despite its many important functions, a patient can live healthily and with few consequences without one.

When is a splenectomy indicated?

• Splenic trauma/avulsion/torsion (e.g. hit by a car, gastric dilatation and volvulus/bloat)
• Splenic tumour (e.g. hemangioma, hemangiosarcoma, mast cell tumour, lymphosarcoma)
• Bleeding tumour (benign or malignant, see above)
• To remove a large volume of blood for certain red blood cell disorders (e.g. polycythemia vera)

NOTE: Removal of a cancerous (i.e. malignant) spleen does not always cure the disease process. Microscopic and sometimes macroscopic disease is left behind or present in other areas of the body before, during or after the time of surgery. Imaging modalities such as chest radiographs (x-rays) and abdominal ultrasound can be used to determine metastatic disease spread prior to surgery. Consultation with a veterinary oncologist to discuss chemotherapy options is part of a comprehensive approach to splenic cancer management.

Is a splenectomy necessary?

The spleen is rich in blood vessels and acts a reservoir for red blood cells for the body. Should the spleen hemorrhage (bleed), a patient can bleed internally into the abdomen resulting in life threatening blood loss, low blood pressure, cardiovascular compromise, weakness and eventually death. Splenectomies prevent further blood loss by removing the organ and stopping the flow of blood connected to it. If a patient has a non-bleeding splenic tumour, removal prevents this life-threatening consequence from occurring in the future. Some success is found with wrapping the belly with a tight ace bandage to stop active splenic bleeds at home, however, removal of the bandage will eventually result in the restarting of active bleeding, making a splenectomy the only life saving option.

NOTE: Choosing non-surgical interventions for a splenic mass (e.g. Chinese nutraceuticals such as Yunnan Baiyo or metronomic chemotherapy prescribed by a veterinary oncologist) should only be considered prior to any active splenic bleeding episodes.

What are the symptoms of splenic hemorrhage/torsion?

• Sudden weakness or collapse (at home or during activity)
• Pale gums
• Cold temperature/extremities

NOTE: Some bleeding splenic tumours will “patch” themselves up by forming blood clots. This temporarily stops the bleeding (and may alleviate symptoms of splenic hemorrhage) for a short time (hours to a few days) but will eventually begin again, putting the patient back at risk for sudden death without immediate medical and surgical intervention.

Complications

• Hemorrhaging (bleeding, from the spleen or associated blood vessels) may occur during surgery. Blood transfusions may be needed prior to, as well as during and after surgery.
• Cardiac arrhythmias (irregular heartbeat) associated with removal of the spleen may occur and may need anti-arrhythmic drugs. Most arrhythmias resolve within a day or two and have no long-lasting consequences.
• Post operative complications (similar to any surgical procedure): dehiscence (opening of the incision), infection, seroma (build up of fluid under the suture line) and suture reaction. Some of these complications may require repeated surgeries to correct.
• Risk of being more susceptible to parasitic blood infections due to the loss of the spleen’s filtering ability.

Prognosis:

• One third (33%) of splenic tumours are benign (hemangioma) whereas two thirds (66%) unfortunately are malignant (e.g. hemangiosarcoma). Histopathology is performed on the removed spleen to determine malignancy.
• If the tumour is malignant, a consultation with a veterinary oncologist is recommended to discuss further treatment options.
• In general, malignant splenic tumours carry a poorer prognosis with a survival time of 2-3 months. Chemotherapy may increase survival times to 6-8 months.
• Benign tumours (hemangioma) carry a good prognosis for survival (i.e., removal provides the cure).

Aftercare following a splenectomy

• Patient will spend one to two days in hospital following a splenectomy (on average) before being discharged.
• Restricted activity for 14 days. Short leash walks only to go to the bathroom. No running, jumping or rough play during this time.
• Pain medications, antibiotics and possibly an iron supplement will be prescribed for the patient following surgery.
• An Elizabethan (E) collar (“cone”) is provided and must be worn at all times to prevent self-trauma of the surgical site. A loose fitting breathable T-shirt or post-surgical onesies may also be considered.
• Daily monitoring of the surgical site. Complications include oozing, a foul smell, swelling or pain at the surgical site. A bandage may be applied to the surgical site to be kept on for the first day (and removed thereafter) after surgery to minimize leaking from the incision.
• The patient may have a thinner silhouette following removal of a large spleen.