The abdominal cavity is a space containing many different organs, such as the spleen, liver, intestines, and bladder.
A hemoabdomen is diagnosed when there is blood in this cavity. This is abnormal since blood does not normally exist in the abdominal cavity freely. This is often called “internal bleeding” and can lead to severe anemia (a low blood count) and eventual death if not treated.
Where Does the Blood in the Abdomen Come From?
The free blood in the abdomen usually comes from one of the organs in the abdominal cavity. The spleen is the most commonly affected organ followed by the liver, adrenal glands and kidneys. Occasionally the blood comes from one of the vessels in the abdomen or the abdominal muscles themselves.
What are the Causes of Hemoabdomen?
Hemoabdomen is divided into two categories: traumatic and spontaneous. Traumatic hemoabdomen usually occurs after a pet sustains a traumatic injury, such as a fall or being hit by a car. Traumatic hemoabdomens rarely require surgery, and the body usually reabsorbs the blood. By contrast, spontaneous hemoabdomen is more common and is most often due to rupture of a tumor present in an abdominal organ(s). This leads to loss of blood from the bleeding tumor because it accumulates in the abdomen instead of staying in the blood vessels/organs where it belongs.
What Kinds of Tumors Can Be Present in My Dog?
Benign or malignant tumors can lead to hemoabdomen. Benign tumors are the kind of tumors that will not spread anywhere else in the body and complete removal can be curative. Malignant tumors are cancers that may spread to other areas in the body and/or recur if not completely removed.
What are the Most Common Benign Tumors Causing Hemoabdomen?
Splenic hematomas and hemangiomas are the most common benign tumors to cause hemoabdomen. Occasionally, benign tumors of the liver or adrenal glands can rupture and cause hemoabdomen.
What are the Most Common Malignant Tumors Causing Hemoabdomen?
Splenic hemangiosarcoma is the most common malignant tumor to cause hemoabdomen. This is a highly aggressive tumor that will eventually spread, even after the spleen has been removed. Hemangiosarcoma can also arise from liver and other locations in the abdomen. Other tumors with potential to rupture include hepatocellular carcinoma (a liver tumor) and adrenal gland malignancies such as adrenocortical carcinoma and pheochromocytoma.
All of the latter are less aggressive than splenic hemangiosarcoma.
What happens During my Visit to the Hospital?
Many patients come to the hospital on an emergency basis. Patients are fully examined to determine the severity of their illness and are treated appropriately to ensure they are stable. This typically involves administering intravenous fluid in order to make the patient feel better and stronger and ready for potential surgery. From a diagnostic standpoint, blood work and thoracic radiographs (chest X-rays) are performed to evaluate the status of the patient’s metabolic systems, as well as to search for any possible metastatic tumors in the chest. When possible, an abdominal ultrasound may be ordered to better evaluate the abdominal organs, determine the tumor location and check for evidence of tumor spread. Once all of this has been done and the patient is deemed ready for definitive treatment, emergency surgery is most often pursued.
Will my Pet Need a Blood Transfusion?
Blood transfusions are not always administered and are considered on a case-by-case basis. Blood transfusions have minimal risks in dogs that have never had a blood transfusion before. However, much like people, allergic reactions are possible and are monitored closely for. MedVet carries all of the different blood products that could potentially be needed for your pet.
What Complications Come with Surgery for Hemoabdomen?
Complications can be related to abdominal surgery in general or related to the specific organ(s) involved. General complications include incisional infections and poor incision healing (reopening of incision). These complications can be minimized with adherence to post-operative care instructions including exercise restriction and prevention of licking the incision area for 2 weeks. General anesthesia itself is a potential risk for all surgical procedures. Complications related to the acute blood loss include severe anemia, heart rhythm disturbances, blood clot formation and sometimes death.
What is the Prognosis for a Dog With Hemoabdomen?
The prognosis is divided into short-term and long-term prognosis. In the short- term, the great majority of dogs having surgery for hemoabdomen recover and are discharged from the hospital within a few of days of surgery. The long-term prognosis is more difficult to determine, and is dictated by the underlying cause, i.e., was the cause a malignant or benign tumor? Surgery for benign tumors can be curative; however, surgery for malignant tumors is not curative, and the long-term prognosis depends on the specific tumor type as determined by biopsy results (results take 3-5 working days).
Hemangiosarcoma, the most common malignancy associated with hemoabdomen, can benefit from postoperative chemotherapy treatment. There have been many studies on the long-term survival for patients with hemangiosarcoma of an abdominal organ, and there is much variation. In general, a pet with hemangiosarcoma having surgery alone has a median survival time of 3-6 months. This median survival time means 50% of pets survive longer then 3-6 months and 50% survive for less time. Medical oncologist directed chemotherapy has the potential to approximately double survival time while maintaining good quality of life (median survival time of 6-9 months). We strongly advise owners of pets with hemangiosarcoma to meet with a medical oncologist and their regular veterinarian to discuss chemotherapy in more detail.
