There is No Such Thing As a "Routine" Spay

One of our patients, in for a spay procedure, tried to die on us yesterday. Thankfully, due to the astute observations and quick actions of the entire team, including the nursing care of her owners overnight, she is doing remarkably well today. There is no such thing as a "routine" spay.
Summit is a year old beautiful Bernese Mountain Dog. She had normal pre-operative blood work, had an IV catheter placed and was given some pre-emptive analgesia medication. Being a larger dog (90 pounds) her surgery was a little longer, but all went well and she recovered uneventfully. She needed more pain relief than is usual, but each patient is an individual and her whining seemed excessive, so she got drugs. It was just after lunch time (we do most of our surgeries in the morning) that one of her nurses noticed that Summit was less responsive to calling her name and her gum color was pale. She asked me to check her out. I noticed her abdomen seemed a bit larger and there was oozing from her incision. There had been oozing from her skin all through out her surgery, so this wasn't too surprising, but I didn't like that large abdomen. I took a fine needle and syringe and aspirated or pulled fluid from her belly. It was pure blood. Lots of it. The staff went into emergency mode.

The receptionist let the waiting appointments know what was happening. Our clients are terrific. Of course it was an imposition, but they actually said that if it was their pet it was happening to, the waiting in line vaccine appointment better be put on hold for them! The rest of the crew got Summit back onto the surgery table and I scrubbed and masked and gowned up again. She was under anesthesia in minutes. With a fresh line of sutures I just followed the dots and opened her back up. I was able to visualize a pool of fresh blood, so I had my nurses collect it rather than just suction it off. I didn't know at that time what kind of volume we were dealing with and what the cause of the loss was. I figured we could save the blood and give it right back to her in an autotransfusion; that's just what we did. We collected the blood with sterile syringes and put it into a transfusion bag, then administered it to her through her IV catheter after filtering it to be sure no blood clots passed through the line. That was significant-no blood clots in the collected blood. There was a clot around the uterine stump when I later explored her abdomen for the source of the bleeding, but no clots in the free blood. She had literally "oozed" all this blood rather than hemorrhaged from large vessels or slipped sutures. It was a mystery, a very serious mystery because without an obvious cause, we couldn't be sure she wouldn't do it again. Regardless, I put ligatures around everything I could, again, making triple ligatures in most places, suctioned her abdomen dry, watched for bleeding, couldn't find any, and closed her up. She was started on antibiotics and more pain medications. She got her blood and a fluid product called hetastarch, and she continued to get IV fluids as well. We monitored her temperature and blood pressure, as well as her gum color. Her owner elected to take her home to nurse her overnight, but brought her back to us this morning for us to reevaluate.

So, what could have gone wrong for Summit? I thought of a couple possibilities. Her owner said there was a condemned house across the street and rats were running around. Rat bait ingestion could cause her to bleed like that. We also had to consider a genetic cause-diseases like Von Willebrand's Disease cause bleeding disorders similar to hemophilia and are found in this breed of dog. We may never know the exact reason, but thankfully, today it looks like she is doing better. Her incision is still oozing a little of the bloody fluid, but her belly doesn't look look like it is filling and her gums are nice and pink. She is up and wagging her tail and eating all the treats we offer her. And MY blood pressure is back to normal.

Peace,
DrReneigh