Successful Splenic Mass Removal in a Senior Labrador

Splenic masses are a relatively common finding in older large-breed dogs, and their management requires careful pre-operative planning, decisive surgical technique, and attentive post-operative care. This case study describes the successful surgical removal of a splenic mass in a 10-year-old male neutered Labrador Retriever, highlighting the clinical decision-making process and the importance of a coordinated team approach.

Presentation and Initial Assessment

The patient was referred following a routine health check during which the primary care veterinarian palpated an abdominal mass. The owner reported that the dog had been slightly lethargic over the preceding two weeks, with a reduced appetite but no episodes of collapse or overt pain. On clinical examination, the patient was bright and responsive with a body condition score of 6/9. Heart rate was mildly elevated at 120 beats per minute, and mucous membranes were pink with a capillary refill time of under two seconds.

Abdominal palpation revealed a firm, non-painful mass in the mid-abdomen, estimated to be approximately 12 centimetres in diameter. The rest of the physical examination was unremarkable.

Diagnostic Workup

A comprehensive pre-operative workup was performed to assess the patient's suitability for surgery and to evaluate for metastatic disease:

• Haematology: Mild anaemia (PCV 32%) with normal white cell count and platelet count within reference range
• Biochemistry: All values within normal limits, including hepatic and renal parameters
• Abdominal ultrasound: Confirmed a 13 x 10 cm heterogeneous mass arising from the splenic body with no free abdominal fluid
• Thoracic radiographs: Three-view thoracic radiographs showed no evidence of pulmonary metastasis
• Coagulation panel: PT and aPTT within normal limits

Surgical Approach

The patient was premedicated with methadone and a low dose of medetomidine, induced with propofol, and maintained on isoflurane in oxygen. A ventral midline coeliotomy was performed, extending from the xiphoid to beyond the umbilicus to ensure adequate exposure.

Upon entering the abdomen, the mass was immediately visible arising from the splenic body. It was well-encapsulated with no evidence of rupture or active haemorrhage. The liver was carefully inspected and palpated with no gross abnormalities detected, though two small hepatic biopsies were taken for histopathological evaluation.

Vascular Ligation

The spleen was carefully exteriorised and the short gastric arteries were individually ligated using 2-0 polydioxanone suture. The splenic artery and vein at the hilum were double-ligated and transected. Haemostasis was meticulously confirmed at each ligation point. Total surgical time was approximately 75 minutes with estimated blood loss of less than 50 millilitres.

Post-Operative Management

The patient recovered smoothly from anaesthesia and was monitored in the intensive care unit for the first 24 hours:

• Continuous ECG monitoring for 48 hours to detect cardiac arrhythmias
• Intravenous fluid therapy at maintenance rate for the first 24 hours
• Multimodal analgesia comprising methadone, meloxicam, and paracetamol
• Serial PCV monitoring at 4, 8, 12, and 24 hours post-surgery

No arrhythmias were detected. The PCV stabilised at 30% and began to rise by 48 hours post-operatively. The patient ate voluntarily within 12 hours of surgery and was comfortable and mobile by the following morning.

Histopathology and Outcome

Histopathological examination revealed the mass to be a splenic haematoma with nodular hyperplasia, a benign finding. The hepatic biopsies showed no abnormalities.

At the two-week post-operative recheck, the incision had healed without complication. The patient was bright, eating well, and had returned to normal activity levels. At the three-month follow-up, the patient continued to do well with no clinical concerns.

Clinical Reflections

• Timely intervention: Early identification and surgical removal before rupture significantly improves outcomes
• Thorough staging: Pre-operative imaging is essential for informed decision-making
• Post-operative vigilance: ECG monitoring following splenectomy is critical as ventricular arrhythmias can occur within 24-72 hours
• Histopathology is essential: Approximately two-thirds of canine splenic masses are benign and surgery should not be withheld based on assumed malignancy