I nicked a spleen.

(i wrote this post back in march, but never posted it).

One morning I was at the shelter in Kansas city, and selected my first surgery for the morning:  a 3-year old, 15ish pound Shih Tzu-like female dog for a spay.  I was happy to have a little dog, as yesterday I had spent the morning working on larger Labish dogs.

We anesthetized her, clipped and prepped her abdomen, and put her on my table for the procedure.

I made the incision along her midline skin, and dissected through a small amouth of subcutanous fat so that her linea alba was plainly visible.  Then, like always, I elevated the linea slightly with tissue forceps, held the scalpel so that the blade was facing up, and made a quick jab incision into her peritoneum.  This is something I had done many times in the past week, but for no good reason, that stab incision went just a bit too deep. I could tell it wasn’t right immediately.

Blood GUSHED from the tiny incision I had made, bubbling up and out of the abdominal cavity. Normally when you cut into the abdomen, there might be a small amount of bleeding, mostly from the initial skin incision,  and in young animals there will be a lot of clear fluid that will ooze from the abdomen. But you really shouldn’t get  too much active bleeding.  No gushing.

I did as I had been instructed by surgery professors throughout my junior year: I took a deep breath.  While trying to quiet the mayday signals going off in my brain, I carefully extended the incision while calling for a shelter vet to let him know that something was wrong. He helped me exteriorize the spleen (a very vascular organ), and sure enough, we could see an obvious gouge  into it. The spleen is a spongy, relatively homogenous organ, and much like a sponge, if you cut into it, you don’t necessarily hurt it’s function. Unlike a sponge, the spleen will bleed relentlessly.

There was music playing from a radio in the prep room, and a long Led Zeppelin song had just started.  The vet wadded up some sterile gauze, held it firmly on top of the gouge, and instructed me to hold it there with very firm pressure.

After 10 minutes or so, I carefully lifted the gauze, and felt my spirits fell as I saw blood eagerly begin to pour forth, as if the last 10 minutes had been 10 seconds. I held firm pressure for two more songs, but the result was the same – there was no cessation of the bleeding.

Ultimately, we pulled out some 4-0 suture material (very small), and placed two sutures to close the gouge. It worked like a charm.

Moral of the story: accidents happen.  Things can go wrong.  No surgery is routine.  Firm pressure is almost always the best way to stop a hemorrhage, but sutures work too.  Practice is awesome, which is why I so loved our surgery program at school – if that had happened while on my own, with a client’s cat or dog, things could have gone a bit differently.

Advertisements

2 thoughts on “I nicked a spleen.

  1. Dr Chryso

    “OMG I nicked the aorta! Oh crap, oh crap!”
    “It’s okay, just put your finger on it.”
    “What??”
    “Digital pressure. It will stop bleeding.”

    A surgical specialist calmly told me this story one time when I’d lost the (bleeding) ovarian pedicle on a routine spay. Now, even as my brain is desperately wanting to panic and send me flailing in circles around the room, I always hear his voice when the abdomen is filling with blood, or the blood is hitting me in the eye. Digital pressure stops bleeding until you can get a clamp or a ligature on it. Even if it’s the aorta. Or the spleen. This knowledge has saved many of my patients and I’m glad he was with me at the time, and I’d gotten to practice and even experience that terror, before I went out and started doing surgery on pets.

  2. Debbie Lee Darnell

    Did the dog in the first surgery listed recover. We just had our female dog cut yesterday and she is not doing well. The Vet thought that maybe she went to deep. What must we watch for?

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s