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Association between previous splenectomy & GDV in dogs | VETgirl Veterinary CE Podcasts

In this VETgirl online veterinary CE podcast, we review the association between previous splenectomy and gastric-dilatation volvulus (GDV) in dogs. Picture this scenario: it’s late into your overnight emergency shift, and you’re cutting a hemoabdomen in a middle age, large breed dog. You found a bleeding splenic mass and removed it, and now you’re trying to decide if you should do a prophylactic gastropexy. Sounds familiar, right? Well, there are actually some theories out there that suggest splenectomy might increase a patient’s risk for GDV, so considering that pexy might be smart. Possible reasons for this increased risk include the void created by removal of the spleen (especially if it was enlarged) leading to increased gastric mobility, or stretching of the ligaments in the cranial abdomen due to a splenic mass, torsion, or previous episodes of gastric dilatation (without volvulus). But, regardless of these theories, previous studies have been mixed, so how are you going to decide if you should pexy this dog that’s on the table?

Well, Sartor et al from the Veterinary Medicine and Surgical Group in Ventura, CA and UPENN wanted to answer this question more definitively by looking at a larger population of dogs in the study “Association between previous splenectomy and gastric dilatation-volvulus in dogs: 453 cases (2004-2009).” In this study, they retrospectively evaluated 151 dogs with GDV and 302 controls without GDV (undergoing abdominal ultrasound or exploratory laparotomy) that were matched by age, body weight, sex, neuter status and breed. What did they find?

4% (n=6) dogs in the GDV group and 1% (n=3) dogs in the control group had a history of splenectomy. The odds of a patient with a previous splenectomy having a GDV were 5.3 times higher than dogs without a history of splenectomy (p=0.04, CI, 1.1 to 26.8). In the dogs with GDV, previous splenectomies were performed from 1.5-12 months before the GDV (with a median of 2.5 months before). Reasons for splenectomy included hematoma (2), lymphoid follicular hyperplasia with hemorrhage (2), benign splenic mass (1) or were not recorded (1). In the control dogs, reasons for previous splenectomy included hemangiosarcoma (1), benign splenic mass (1) or were not recorded (1).

So, what can we take away from this VETgirl podcast?

Unlike previous studies, this retrospective study suggests that there is an association between previous splenectomy and GDV, although the incidence is small. The authors suggest that the low incidence may be the reason for negative findings in previous smaller studies. While splenic torsion has been suggested as the common splenic condition predisposing patients to GDV in the past, that finding was not true for this study, in which patients with splenectomy that went on to develop GDV had a variety of splenic conditions, including benign hematomas.

So, the authors stress that the decision to perform a gastropexy in patients undergoing splenectomy should be based not only on removal of the spleen, but also other risk factors (age, breed, underlying disease, etc.) as well as the stability of the patient under anesthesia.

Overall, this was a well-done, matched case-control retrospective study that set out to answer one specific question. It is well organized, concise and to the point. Because of the study’s retrospective nature, looking at other risk factors for GDV (for example, feeding habits, environment, etc.) was not possible, so it’s hard to say if these other factors played a role. In conclusion, if that dog you’re currently cutting is doing well under anesthesia and has other risk factors for GDV, performing a gastropexy is probably a good idea!

References:
1. Sartor AJ, Bentley AM, Brown DC. Association between previous splenectomy and gastric dilatation-volvulus in dogs: 453 cases (2004-2009). J Am Vet Med Assoc 2013;242:1381-1384.

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