Prognosis for Acute Nontraumatic Hemoperitoneum in the Dog: A Retrospective Analysis of 60 Cases (2003–2006)
The complete medical records of 60 dogs with hemoabdomen were reviewed. All dogs underwent exploratory laparotomy and had a diagnosis established by a veterinary pathologist. Final diagnoses were hemangiosarcoma in 38 (63.3%) dogs, splenic hematoma in 16 (26.6%) dogs, splenic torsion in three (5%) dogs, hepatocellular carcinoma in two (3.3%) dogs, and carcinomatosis in one (1.6%) dog. Twenty-four (63.1%) dogs with hemangiosarcoma, 14 (87.5%) dogs with splenic hematoma, three (100%) dogs with splenic torsion, and two (100%) dogs with hepatocellular carcinoma were discharged from the hospital. Dogs with hemangiosarcoma were given a poor prognosis, while dogs with splenic hematoma, splenic torsion, and hepatocellular carcinoma were given a fair to good prognosis.
Introduction
A limited number of clinical reports have described the features of acute traumatic and acute nontraumatic hemoperitoneum in the dog.1–3 Nonpenetrating traumatic hemoperitoneum is the result of a blunt injury (usually automobile trauma) resulting in hemorrhage from intraabdominal organs, most commonly the spleen or liver. Nontraumatic hemoperitoneum is the accumulation of free blood in the abdominal cavity without known trauma as a predisposing factor. As with traumatic hemoperitoneum, nontraumatic hemorrhage usually occurs from the spleen or liver.
Whether traumatic or nontraumatic, clinical signs associated with acute hemoperitoneum are related to hypovolemic shock and include weakness or collapse, pale mucous membranes, delayed capillary refill time, tachypnea, dyspnea, and tachycardia. Diagnostic testing and definitive treatment must be started as soon as possible for optimal results. Diagnostic tests include complete blood count (CBC), serum biochemical and plasma clotting profiles, abdominocentesis, thoracic and abdominal radiography, blood pressure measurements, electrocardiogram (ECG), and possibly abdominal ultrasonography. Treatments include management of hypovolemic shock, blood replacement therapy, external abdominal counter-pressure, and surgical intervention. Acute nontraumatic hemoperitoneum has been reported in dogs with benign or malignant conditions of the spleen, liver, kidney, prostate, and adrenal gland; splenic and liver lobe torsion; and coagulopathies.2–5
The objectives of this study are to review the clinical features of a group of dogs with acute nontraumatic hemoperitoneum and to define the source and cause of the hemorrhage. The results of this study will enable clinicians to formulate a reasonable prognosis and plan for dogs with acute nontraumatic hemoperitoneum.
Materials and Methods
Medical records of dogs presented to Veterinary Specialists of South Florida between January 2003 and July 2006 were reviewed. Only dogs that met all of the following criteria were included in this study: 1) one or more episodes of weakness and/or collapse prior to presentation; 2) nonclotting blood present in the abdominal cavity with no history of trauma; 3) exploratory laparotomy was performed to determine the source of the hemorrhage; 4) a final tissue diagnosis was established by a board-certified veterinary pathologist; and 5) complete medical records were available for analysis. Sixty dogs met the criteria for inclusion in this study.
Information retrieved from medical records included signalment; history; physical examination findings; clinicopathological, radiographic, ultrasonographic, and surgical findings; histopathological diagnosis; and perioperative outcome. The perioperative period in this study was defined as the time from the start of surgery until discharge from the hospital. All cases were followed until discharge from the hospital, since follow-up was not a goal of this study. Specific parameters reviewed for this study included presenting complaint, duration of illness, breed, age, weight, mucous membrane appearance, capillary refill time, respiratory rate and efficiency, presence or absence of abdominal distention, results of abdominal palpation, evaluation of abdominal fluid, thoracic and abdominal radiographs, CBC, serum biochemical profile, and hemostatic profile. Not all of the above-mentioned parameters were performed in every case.
During surgery, continuous monitoring of body temperature, oxygen saturation, expiratory carbon dioxide, ECG, blood pressure, and respiratory rate was standard in all cases. Dogs were blood-typed and cross-matched for potential blood transfusions when indicated. Packed red cells, whole fresh blood, hemoglobin glutamer-200 (Bovine),a and fresh-frozen plasma were also available. Blood pressure monitoring was performed in all cases by direct or indirect methods. Arterial catheterization for direct blood pressure monitoring was attempted in critical cases, and, if unsuccessful, then oscillometric blood pressure monitoring was performed. Hypothermia was treated by passive and active rewarming using circulating warm-water blankets and forced warm air blankets.b Reusable stapling devicesc were routinely used when splenectomy and liver lobectomy were performed. Continuous ECG monitoring was used postoperatively in all cases of splenectomy and in other cases when indicated. During abdominal exploration, the abdomen was evacuated of free blood and blood clots. The criteria used to determine the source of hemorrhage included visualization of active bleeding, an obvious rent or tear in a mass lesion, the presence of omental adhesions to a mass lesion, and the localization of blood clots adjacent to a mass lesion. All dogs were recovered in a fully staffed, 24-hour intensive care unit. Surgical procedures were performed by surgeons (ACVS diplomates) as well as ACVECC residents and surgical interns who were specifically trained to conform to the protocol described here.
Results
Of the 60 dogs that met the criteria for this study, 38 (63.3%) had a final diagnosis of hemangiosarcoma, 16 (26.6%) were diagnosed with splenic hematoma, three (5%) had splenic torsion, two (3.3%) had a diagnosis of hepatocellular carcinoma, and one (1.6%) was diagnosed with generalized anaplastic carcinoma of the abdominal cavity.
Hemangiosarcoma
Purebred dogs with hemangiosarcoma represented more than once in this study were 10 (31.5%) German shepherd dogs, four (10.5%) Labrador retrievers, three (7.8%) boxers, and two (5.2%) golden retrievers. The mean weight of dogs with a final diagnosis of hemangiosarcoma was 35 kg (range 12.7 to 53.6 kg) or 78.2 lb (range 28 to 118 lb), and the mean age was 9.3 years (range 5 to 15 years).
The mean hematocrit in dogs with hemangiosarcoma was 29.8% (reference range 37% to 55%; range 17% to 45%); the mean platelet count was 202,000 μ/L (reference range 200,000 to 500,000 μ/L; range 20,000 to 645,000 μ/L); and the mean white blood count (WBC) was 20,800 μ/L (reference range 6000 to 17,000 μ/L; range 6300 to 55,900 μ/L). The mean total protein (TP) was 5.76 g/dL (reference range 5.2 to 8.2 g/dL; range 4.4 to 7.1 g/dL). The prothrombin time (PT) was recorded in 22 dogs, and the activated partial thromboplastin time (aPTT) was recorded in 19 dogs. The mean PT was 15.9 seconds (reference range 12 to 17 seconds; range 9 to 21 seconds), and the mean aPTT was 126.4 seconds (reference range 71 to 102 seconds; range 73 to 400 seconds).
The abdominal organs believed to be the primary sources of bleeding were the spleen in 28 (73.6%) dogs, the liver in six (15.7%) dogs, a kidney in two (5.2%) dogs, and the prostate gland in two (5.2%) dogs. At surgery, hemangiosarcoma was suspected and later confirmed in other abdominal organs in 18 (47%) dogs. One dog had several pulmonary nodules, but the owner decided to pursue surgery against medical advice. Ten dogs had confirmed hemangiosarcoma in both the spleen and the liver, and four had confirmed hemangiosarcoma in both the spleen and the omentum; however, the spleen was found to be the primary source of bleeding in these cases. One dog had hemangiosarcoma in a kidney and multiple hemangiosarcoma nodules throughout the liver, and another dog had a large bleeding liver mass with smaller hemangiosarcoma nodules in multiple liver lobes. Two dogs had intraabdominal hemangiosarcoma nodules in multiple organs; however, the origin of the hemorrhage was a splenic mass confirmed to be hemangiosarcoma in both cases.
Fifteen (39%) dogs with hemangiosarcoma received a total of 21 blood products. Blood products included packed red blood cells (11 units), fresh whole blood (six units), hemoglobin glutame-200 (Bovine) (two units), and fresh-frozen plasma (two units).
Eleven (28.9%) dogs were treated intraoperatively for hypotension with 6% hetastarchd (10 to 20 mL/kg [4.5 to 9 mg/lb] as an intravenous [IV] bolus), dopaminee (1 to 5 μg/kg per minute [0.45 to 2.27 μg/lb per minute] as an IV constant-rate infusion [CRI]), or both.
Eleven (44%) of the 25 dogs that survived surgery developed significant ventricular arrhythmias postoperatively and were treated with lidocainef (1 to 2 mg/kg [0.45 to 0.9 mg/lb] as an IV bolus, and/or 50 to 80 μg/kg per minute [22.7 to 36.4 μg/lb per minute] as an IV CRI) and/or procainamideg (10 to 15 mg/kg [4.5 to 6.8 mg/lb] as an IV bolus and/or 25 to 50 μg/kg per minute [11.4 to 22.7 μg/lb per minute] as an IV CRI). In eight dogs, the primary site of hemorrhage was the spleen, while the primary sites of bleeding in the other three dogs were the liver, kidney, and prostate gland. Two dogs were discharged with oral antiarrhythmic drugs—one with procainamide (10 to 20 mg/kg [4.5 to 9.0 mg/lb] per os [PO] q 6 to 8 hours) and one with sotalolh (0.5 to 2.0 mg/kg [0.22 to 0.9 mg/lb] PO q 12 to 24 hours).
Thirteen (34.2%) dogs were euthanized on the operating table, and one (2.6%) died in the immediate postoperative period from pneumonia. Of the 24 (63.1%) dogs with hemangiosarcoma that were ultimately discharged from the hospital, seven had confirmed abdominal metastases. In these cases, a diagnosis of metastatic disease was not established until the final pathology report was available, which was usually several days after surgery, and the dog had already been released.
Splenic Hematoma
Purebred dogs with splenic hematoma represented more than once in this study were three (18.7%) Labrador retrievers, two (12.5%) German shepherd dogs, and two (12.5%) Rhodesian ridgebacks. The mean weight of dogs with splenic hematoma was 37.6 kg (range 6.3 to 60.5 kg) or 82.8 lb (range 14 to 133 lb), and the mean age was 9.5 years (range 2 to 14 years).
The mean hematocrit in dogs with splenic hematoma was 30.8% (reference range 37% to 55%; range 15% to 44%); the mean platelet count was 320,000 μ/L (reference range 200 to 500 μ/L; range 40,000 to 801,000 μ/L); and the mean WBC was 16,500 μ/L (reference range 6000 to 17,000 μ/L; range 4300 to 35,600 μ/L). The mean TPwas 6.32 g/dL (reference range 5.2 to 8.2 g/dL; range 4.4 to 7.8 g/dL). The PT was recorded in 15 dogs, and the aPTT was recorded in 11 dogs. The mean PT was 14.5 seconds (reference range 12 to 17 seconds; range 8 to 18 seconds), and the mean aPTT was 91.5 seconds (reference range 71 to 102 seconds; range 21 to 106 seconds).
Six (37.5%) dogs with splenic hematoma received a total of 12 blood products. Blood products included packed red blood cells (six units), fresh whole blood (three units), hemoglobin glutamer-200 (bovine) (one unit), and fresh-frozen plasma (two units).
Six (37.5%) dogs were treated intraoperatively for hypotension with 6% hetastarch, dopamine, or both. Thirteen (86.6%) of the 15 dogs that survived surgery developed significant cardiac arrhythmias postoperatively and were treated with lidocaine and/or procainamide via bolus or CRI. Four dogs were discharged with oral antiarrhythmic drugs—two with procainamide and two with sotalol.
Splenectomy was performed in all dogs with splenic hematoma caused by rupture of the spleen. Complete abdominal exploratory revealed no other significant abnormalities. Fourteen (87.5%) dogs were discharged from the hospital. One dog was euthanized on the operating table because of massive blood loss and nonresponsive hypothermia and hypovolemia; another dog died 2 days after surgery from anemia and hypovolemic shock.
Splenic Torsion
One German shepherd dog, one English mastiff, and one Great Dane had splenic torsion in this study. The mean weight of the three dogs was 55 kg (range 36 to 75 kg) or 121 lb (range 80 to 165 lb). The mean age was 4 years (range 2 to 6 years).
The mean hematocrit in dogs with splenic torsion was 25% (reference range 37% to 55%; range 21% to 28%); the mean platelet count was 79,000 μ/L (reference range 200,000 to 500,000 μ/L; range 62,000 to 96,000 μ/L); and the mean WBC was 27,000 μ/L (reference range 6000 to 17,000 μ/L; range 24,000 to 30,000 μ/L). The PT was recorded in two dogs, and the aPPT was recorded in two dogs. The mean PT was 14.5 seconds (reference range 12 to 17 seconds; range 14 to 15 seconds), and the mean aPTT was 93 seconds (reference range 71 to 102 seconds; range 89 to 97 seconds).
Two (66.6%) dogs received a total of four blood products because of anemia and signs consistent with hypovolemia. One dog received two units of packed red blood cells, and one dog received one unit of packed red blood cells and one unit of fresh whole blood. One dog required a CRI of lidocaine after surgery due to ventricular arrhythmias. All three dogs with splenic torsion recovered from surgery and were discharged from the hospital.
Hepatocellular Carcinoma
The mean weight of the two dogs with hepatocellular carcinoma in this study was 28.6 kg (range 22.7 to 34.5 kg) or 63 lb (range 50 to 76 lb). The mean age was 8 years (range 2 to 12 years). The mean hematocrit was 28% (reference range 37% to 55%; range 18% to 38%); the mean platelet count was 226,500 μ/L (reference range 200,000 to 500,000 μ/L; range 223,000 to 230,000 μ/L); the mean WBC was 10,500 μ/L (reference range 6000 to 17,000 μ/L; range 9000 to 12,000 μ/L); the mean PT was 18.5 seconds (reference range 12 to 17 seconds; range 16 to 21 seconds); and the mean aPTT was 149 seconds (reference range 71 to 102 seconds; range 106 to 192 seconds).
In both dogs, one liver lobe was involved; the gross tumor was completely removed; and the final histopathological diagnosis was well-differentiated hepatocellular carcinoma. One (50%) dog developed significant cardiac arrhythmias postoperatively and was treated with lidocaine boluses and a lidocaine CRI. One (50%) dog received a unit of fresh whole blood and a unit of fresh-frozen plasma. Both dogs were discharged from the hospital.
Adenocarcinoma
The dog with generalized anaplastic adenocarcinoma of the abdomen (carcinomatosis) was a 4-year-old, mixed-breed dog that weighed 25.5 kg (56 lb). The origin of the carcinoma could not be determined. The hematocrit, platelet count, PT, and aPTT were within normal limits. The WBC was 63,000 μ/L (reference range 6000 to 17,000 μ/L). Free blood (1 L) was in the abdominal cavity. Tumor was present on all serosal surfaces, and locating the source of the bleeding was difficult. The dog was euthanized during surgery.
Discussion
The term acute, as used in this study, describes a disease process that is brief, severe, and quickly comes to a crisis.6 The most common presenting clinical signs in this series of dogs included lethargy, weakness, and collapse (either as a single event or an episodic problem), which were attributed to hypovolemia and anemia resulting from blood loss into the abdominal cavity. The length of time that these signs were apparent to the owners was quite variable, ranging from a few weeks to a few hours in duration. Clinical signs will vary according to the rate and duration of blood loss, the condition of the animal’s hemostatic mechanisms, and other concurrent medical problems.
It is well recognized that German shepherd dogs, Labrador retrievers, and golden retrievers are at a higher risk than the general population for developing abdominal hemangiosarcoma and splenic hematoma.1–3,7–14 The findings of this study support the breed predisposition data from the previous reports. In this present study, three (7.8%) boxers were represented in the hemangiosarcoma group, and two (12.5%) Rhodesian ridgebacks developed ruptured splenic hematoma. The results from this study were consistent with previous reports that older and larger dogs are pre-disposed to hemangiosarcoma and splenic hematoma.2,7–13 In a study of 19 dogs with splenic torsion, this condition was shown to appear in large dogs, particularly the Great Dane (26.3%) and German shepherd breeds (26.3%). Splenic torsion occurs at a mean age of 5.5 years (range 1.5 to 11 years).15 In the present study, one (33.3%) Great Dane and one (33.3%) German shepherd dog had splenic torsion, and the mean age was 4 years (range 2 to 6 years). Since only three (5%) of the dogs in this study had splenic torsion, and the age ranges of dogs with hemangiosarcoma, splenic hematoma, and splenic torsion overlapped, differentiating among these conditions based on the dog’s age is not possible.
In this study, the spleen was thought to be the most common primary source of bleeding, and the liver the second most common source, which is consistent with other reports of nontraumatic hemoabdomen.2,3,14 In the majority of cases, plain radiographs were not helpful in determining the source of the hemorrhage because of a generalized loss of serosal detail associated with hemoabdomen. While ultrasonography has been shown to aid in the initial diagnosis of hemoabdomen, it has not been useful in locating the source of the bleeding. More importantly, ultrasonography has not been a consistent technique for differentiating between benign and malignant disease because of the common presence of benign masses or nodules in the liver and spleen of older patients that cannot be differentiated from primary or metastatic lesions.2,12 Since the majority of dogs with hemoabdomen in this study were presented at times when an experienced radiologist was not available, formal ultrasonography was only performed in 17 cases—none of which were excluded from exploratory laparotomy based on the results of the study.
The amount of free blood in the abdominal cavity was not recorded in all cases, and it was only approximated by the nursing staff or surgical assistant in some cases. Quantifying the true volume of free blood in the abdomen was difficult because of the presence of blood clots in some cases and the fact that some residual blood remained in the abdominal cavity after aspiration.
Veterinary pathologists in three large studies of 1480, 500, and 87 cases have studied the prevalence and classification of diseases of the canine spleen retrospectively.7–9 These studies characterized splenic diseases histologically in dogs. The occurrence of splenic hemangiosarcoma in these reports varied between 10% and 24%, while the incidence of splenic hematoma was 10% to 20% in all spleens examined. Lesions consistent with splenic torsion were present in 0.5% to 5% of spleens examined. Since superimposed splenic hematomas were observed in many hyperplastic splenic nodules, these lesions are believed to be related. A continuum may exist for progression of splenic nodular hyperplasia to hematoma that may represent the pathogenic mechanism for the formation of splenic hematomas in dogs.7,8
Hemangiosarcoma and splenic hematoma have been reported to be grossly indistinguishable from each other in most cases, and it has been strongly recommended that the entire spleen be submitted to a veterinary pathologist so that multiple tissue specimens can be selected to insure an accurate diagnosis.7–9,11,13 Primary hemangiosarcoma of the spleen is often multifocal with smaller individual nodules than splenic hematoma, and it has a cavitated or honey-combed appearance on cut section.7 Pathologists have also reported that it can be difficult to distinguish between hemangiosarcoma and splenic hematoma at the microscopic level.10,11 Besides touch preparations and preparation of multiple sections from selected areas of the entire mass, electron microscopy has been employed in human medicine to prevent a misdiagnosis.11 In a study of 92 dogs with splenic hemangiosarcoma and 125 dogs with splenic hematoma, three dogs with an original diagnosis of splenic hematoma were reclassified as having hemangiosarcoma when two independent pathologists reviewed the slides during preparation of the manuscript.11
Ventricular arrhythmias are a common finding in dogs undergoing splenectomy, and continuous intraoperative and postoperative ECG monitoring is recommended.16,17 In one study, 38.5% of dogs with splenic hemangiosarcoma and 34.1% of dogs with splenic hematoma had ventricular arrhythmias before, during, and after surgery.16 In another study, 85.7% of dogs with splenic hemangiosarcoma, 31.3% of dogs with splenic hematoma, and 100% of dogs with splenic torsion had intraoperative and/or postoperative ventricular arrhythmias.17 In a study of 19 dogs with splenic torsion, seven (36.8%) had ventricular arrhythmias recorded in the intraoperative or postoperative period.15 In a study of 42 dogs that had liver lobectomy for solitary hepatocellular carcinoma, ventricular arrhythmias were not recorded in any case.18 In the present study, 11 (44%) of 25 dogs that survived surgery for hemangiosarcoma, 13 (86.6%) of 15 dogs that survived surgery for splenic hematoma, one (33%) dog with splenic torsion, and two (100%) dogs with hepatocellular carcinoma had ventricular arrhythmias considered significant enough to warrant treatment. Significant arrhythmias that required treatment developed in three dogs with hemangiosarcoma in which the liver, kidney, and prostate gland—not the spleen—were the primary sites of hemorrhage. It is therefore recommended that continuous ECG monitoring be employed in all cases of hemoabdomen.
In the present study, 14 (36.8%) dogs with hemangiosarcoma and two (12.5%) dogs with splenic hematoma were euthanized or died in the perioperative period. These deaths were attributed to obvious metastatic disease and poor prognosis on the operating table or to anemia, hypovolemia, or pneumonia in the immediate postoperative period.
In a study in which 500 canine spleens were surgically removed and examined, 31 (15%) of 203 dogs with a diagnosis of nodular hyperplasia/splenic hematoma complex died in the surgical recovery period.8 Deaths were attributed to hemorrhagic shock and respiratory failure in most cases. Of the 115 dogs with splenic hemangiosarcoma, 38 (33%) died within 2 weeks after surgery; most died within 48 hours. The number of dogs with hemoabdomen in this study was not reported, and dogs with nodular hyperplasia of the spleen and/or splenic hematoma were treated as one group.
In the present study, 24 (63.1%) dogs with primary abdominal hemangiosarcoma, 14 (87.5%) dogs with a final diagnosis of splenic hematoma, three (100%) dogs with splenic torsion, and two (100%) dogs with hepatocellular carcinoma were discharged from the hospital. No survival studies were done in these dogs, because significant numbers of dogs with splenic hemangiosarcoma and splenic hematoma have previously been followed to determine survival rates and to correlate tissue diagnosis and prognosis, and findings have been published elsewhere.7,8,11,13,14
In a report that included 59 dogs with splenic hemangiosarcoma, 91 dogs with splenic hematoma, and 84 matched control dogs, the mean survival time of the dogs with hemangiosarcoma was 19 days (range 0 to 480 days), while dogs with splenic hematoma had a mean survival time of 338 days (range 0 to 730 days), and the matched control dogs had a mean survival time of 617 days (range 8 to 730 days).11 These results suggest that the diagnosis of splenic hematoma may not have been correct in all cases, that removal of the spleen may adversely affect long-term survival, or that the stresses of major blood loss and surgery may be a factor in survivability.
In a report of 500 dogs in which splenectomy was performed and the entire spleen was submitted and examined histologically, 115 dogs had a diagnosis of hemangiosarcoma, while 203 dogs had a diagnosis of nodular hyperplasia/splenic hematoma complex.8 Thirty-six (31%) dogs with hemangiosarcoma were alive at 2 months, and eight (7%) were alive at 1 year; 169 (83%) dogs with nodular hyperplasia/splenic hematoma complex were alive at 2 months, and 130 (64%) dogs were alive at 1 year. The overall survival rate was 52% based on the number of dogs that had splenectomy for any reason and were still alive at least 6 months postoperatively.
In a retrospective study of 104 dogs with hemangiosarcoma, it was reported that hemangiosarcoma carries a poor prognosis regardless of the location.14 Dogs with stage I, II, or III primary splenic hemangiosarcoma had mean survival times of 151, 107, and 73 days respectively. No statistical difference in survival time among the three groups was found, and combination chemotherapy had no effect on survivability. 14 In a study of 19 dogs in which splenectomy was performed for splenic torsion, none of the 12 dogs for which long-term outcome was available developed morbidity or mortality associated with torsion of the spleen.15
In a report of 48 dogs with solitary hepatocellular carcinoma in which 42 were resected, the median survival time was not reached and was >1460 days (range 1 to 1460 days; mean 409 days).18 No dogs developed local recurrence of the tumor; however, two dogs developed metastatic disease. Although two dogs presented with ascites, none of the 48 dogs with hepatocellular carcinoma presented with hemoabdomen. 18 Based on these reports, dogs with splenic hemangiosarcoma have an extremely poor prognosis, while dogs with splenic hematoma, splenic torsion, or hepatocellular carcinoma have a fair to good prognosis.
Conclusion
Because of the recommendation of the attending veterinarian and financial or other owner considerations, surgical treatment was not pursued in all dogs with hemoabdomen presented to Veterinary Specialists of South Florida between January 2003 and July 2006. Nontraumatic hemoabdomen is considered to be a poor prognostic indicator, and dogs with hemoperitoneum have been shown to be significantly more likely to have hemangiosarcoma than splenic hematoma.11,13
Since this was a retrospective study, results reflect the findings in this series of dogs only. Survival data were not determined in this study, because dogs were followed only until discharge from the hospital. However, other studies have documented survival data in dogs with hemangiosarcoma, splenic hematoma, splenic torsion, and hepatocellular carcinoma.7,8,11,13,14 Distinguishing between benign or malignant intraabdominal disease based on history, signalment, physical findings, laboratory data, radiographs, and ultrasound examination was not possible prior to surgery in this series of dogs. This was particularly evident when comparing dogs with intraabdominal bleeding resulting from hemangiosarcoma to dogs with splenic hematoma. Any dog presented with hemoabdomen should be considered to have a life-threatening disease process; however, with timely surgical intervention, a considerable number of these dogs can have long-term survival times.
In order for owners to make informed decisions surrounding the resolution of hemoperitoneum in the dog and any future treatments that may be necessary, it is essential that a frank discussion be held with owners regarding the prognosis and the financial commitment required for treatment.
Oxyglobin; Biopure Corporation, Cambridge, MA 02141
Bair Huggar; Arizant Medical, Eden Prairie, MN 55344
LDS-2 and TA Premium; US Surgical Corporation, Norwalk, CT 06850
Hetastarch 6%; Gensia Sicor Pharmaceuticals, Irvine, CA 92618
Dopamine HCl; Abbott Laboratories, Abbott Park, IL 60064
Xylocaine; Astra USA, Wayne, PA 19087
Pronestyl; Princeton Pharmaceutical-US, Princeton, NJ 08543
Betapace; Berlix Laboratories, Montville, NJ 07045
