Brady is a six-year-old golden retriever who presented after collapsing during his after-dinner walk. His owners reported that while he may have been acting a little quiet in the last few days, overall nothing out of the ordinary had changed in his behavior.
When Brady arrived at the hospital he was able to walk but was very weak. His gums were an extremely pale pink--almost white--and his abdomen was distended – the classic signs of a belly full of blood, also called a hemoabdomen.
My suspicion was confirmed when I inserted a needle into his belly and pulled back a syringe full of blood. Because Brady was losing so much blood into his abdomen, he needed help to support his cardiovascular system, so we immediately placed an intravenous catheter and started him on fluids. His red blood cell count was predictably low as was his blood pressure; we needed to start supportive care to help him oxygenate his organs. He was given oxygen and a medication called hetastarch to help bring up his blood pressure.
After I was comfortable that Brady was receiving the supportive care he needed, I headed into a room to have what is always a very difficult discussion with his owners.
The most common cause of a hemoabdomen is a bleeding tumor in the spleen. Though there is a small chance that the tumor is benign, it is much more likely that it is a very aggressive type of cancer called hemangiosarcoma, a cancer of the cells that line blood vessels.
Not only was it most likely that this was a malignant tumor, there was also a strong possibility that it had already spread to his liver or lungs. Even though x-rays of Brady’s lungs did not show any metastasis, there could be microscopic disease present that just hadn’t become visible on x-rays.
His owners had three options at this point:
1) They could choose to euthanize immediately, reasoning that the tumor was most likely malignant and that it had spread, so that even if we went to surgery and removed it, Brady would need chemotherapy to treat the suspected metastasis.
2)They could wait until the next day when Brady could have an ultrasound to see if there was any evidence of metastasis to the liver. If the liver was clean then we would proceed to surgery to remove the spleen. The problem with waiting was Brady risked sudden death if the tumor were to rupture.
3)Brady could go to surgery immediately to have the spleen removed. In surgery we would assess the liver for obvious metastasis. If any lesions in the liver were present this would indicate a very poor prognosis and we would recommend that he be euthanized while under anesthesia. If the liver appeared normal we would proceed and submit biopsy samples of the liver and spleen.
My heart always goes out to the owners when it is necessary to have this overwhelming discussion. There are multiple options with varied outcomes and they need to make a life or death decision for their dog with very little time to think. After much discussion, Brady’s owners elected for him to have the emergency surgery.
In surgery, Brady’s abdomen was filled with blood from a large bleeding mass in his spleen. Fortunately, his liver was normal in appearance, so we proceeded to remove the spleen as quickly as possible to prevent further blood loss. I also took a sample of liver tissue to submit along with the spleen for review by a pathologist. Despite his severe anemia, Brady did very well during surgery and his recovery from anesthesia was uneventful.
Now we had to wait for the pathologist to send back the results of the biopsy samples. Six days later Brady’s owners were given a very happy and unexpected surprise: The mass was the benign form of disease called a hemangioma, and the surgical excision was expected to be curative.
I was thrilled for Brady and his owners, especially because after treating my own dog for hemangiosarcoma, I would not wish it on anyone. Unfortunately, this is not the usual outcome when a dog presents with a hemoabdomen and it is always a gamble no matter what decision the owner makes.
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