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Splenic Torsion 935

PEARLS & CONSIDERATIONS • Significantly lower serum vitamin D State University Veterinary Clinical Pharmacol-
concentrations in dogs with Spirocerca ogy Lab (https://vcpl.vetmed.wsu.edu/).
Comments
VetBooks.ir • In North America and Europe, spirocercosis with esophageal neoplasia) may offer new SUGGESTED READING Diseases and Disorders
granulomas (and even lower levels in those
is a rare disease and is considered only when
insights in the mechanism and/or treatment
Lobetti R: Successful resolution of oesophageal
there is a high index of clinical suspicion.
• The characteristic lesion is a soft-tissue mass of spirocercosis. spirocercosis in 20 dogs following daily treatment
with oral doramectin. Vet J 193(1):277-278, 2012.
in the caudal esophagus; radiographically Prevention AUTHOR: Steven L. Marks, BVSc, MS, DACVIM
and clinically, foreign-body ingestion is an Prevent dogs from eating beetles or paratenic EDITOR: Rance K. Sellon, DVM, PhD, DACVIM
important differential diagnosis. hosts.
• A minority of dogs develops neoplastic
transformation of esophageal granulomas Technician Tips
(e.g., 13 of 14 dogs with spirocercosis had Testing for the MDR1/ABCB1-Δ mutation is
esophageal masses, but only 1 of 13 had easily accomplished by submitting an EDTA
esophageal neoplasia). blood sample or cheek swab to the Washington

Splenic Torsion Client Education
Sheet

BASIC INFORMATION • Lethargy, anorexia, vomiting, diarrhea, • Serum biochemistry profile: increased alkaline
polyuria/polydipsia, discolored urine, weight phosphatase, alanine aminotransferase, bili-
Definition loss rubin concentrations. Hemolysis of sample
Twisting and rotation of the spleen around often noted
its vascular pedicle, resulting in occlusion and PHYSICAL EXAM FINDINGS • Coagulation profile
thrombosis of vasculature and splenic conges- • Abdominal distention • Urinalysis: hemoglobinuria common
tion and ischemia • Mid-abdominal mass/splenomegaly • Abdominal radiographs: splenomegaly
• Signs of hypotensive shock if acute form ○ Spleen may have a reversed C shape.
Epidemiology (tachycardia, pallor, prolonged capillary refill ○ Gas opacities in spleen in chronic
SPECIES, AGE, SEX time, weak peripheral pulse) torsions
Dogs: ○ Loss of abdominal detail consistent with
• Deep-chested large and giant breeds (Great Etiology and Pathophysiology effusion
Dane, Saint Bernard, German shepherd, Irish • Twisting of vasculature results in venous ○ Displacement of small intestine
setter) occlusion first. The arterial system remains • Abdominal ultrasound
• No age predisposition patent, resulting in a large and painful spleen. ○ Generalized splenomegaly
• Males more commonly affected • Proposed mechanism ○ Lacy, diffusely hypoechoic splenic
○ Gastric distention repeatedly stretches parenchyma
RISK FACTORS gastrosplenic and splenocolic ligaments, ○ Thrombi located within splenic vasculature
Spontaneously resolving gastric dilation and allowing splenic hypermotility. ○ Color-flow Doppler: decreased blood flow
volvulus (GDV) can occur in conjunction with ○ Spontaneous resolution of GDV may leave to the hilar vessels
splenic torsion the spleen in a rotated position. • Electrocardiogram (ECG): ventricular
• Intravascular microangiopathic hemolysis is arrhythmias are common.
ASSOCIATED DISORDERS a common complication.
• GDV (can occur following splenectomy for Advanced or Confirmatory Testing
splenic torsion) DIAGNOSIS CT: corkscrew-like soft-tissue mass in the
• Splenic infarction location of the splenic artery and vein
Diagnostic Overview
Clinical Presentation Diagnosis is suspected based on patient sig-
DISEASE FORMS/SUBTYPES nalment, history, and physical exam findings. TREATMENT
• Acute Abdominal diagnostic imaging (radiography, Treatment Overview
• Chronic ultrasound) demonstrates the uniformly Splenectomy is the required treatment and
enlarged, malpositioned spleen. should be performed as soon as the patient is
HISTORY, CHIEF COMPLAINT stable. Intensive postoperative care is necessary.
Acute: Differential Diagnosis
• Collapse • Splenic mass Acute General Treatment
• ± GDV and associated signs • Neoplasia of other abdominal organs Preoperative patient stabilization
• Signs of hypovolemic or toxic shock • GDV • Correct fluid and electrolyte imbalances.
Chronic: • Mesenteric volvulus • Blood transfusion: if hematocrit < 20% (p.
• Vague, nonspecific history: difficult to 1169)
distinguish from other disorders that cause Initial Database • Treat cardiac arrhythmias (pp. 1033 and 1457)
signs of abdominal pain • CBC: anemia, leukocytosis (stress leukogram • Preoperative and perioperative broad-
• Signs may be present for up to 3 weeks. common) spectrum antibiotics

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