Ultrasonography guidance for total splenectomy in donkeys

Abstract

There are varieties of surgical approaches reported for equine splenectomy and all of them were dealing with the most reachable situation of splenic hilus and easy handling of the spleen. The aim of this work was to establish the normal ultrasound parameters of spleen in donkeys (normal echogenicity, hilus situation, topographic location and correlation with neighboring organs) as a guide to select the best approach for total splenectomy in donkeys. Splenic ultrasound was carried out on six normal donkeys before experimental total splenectomy in the standing position. The splenic topographic location was recorded among 4 rows including 30 squares. These animals were divided into two groups according to the surgical approach of total splenectomy. Total splenectomy after left 16^th and 17^th ribs partial resection in standing position was carried out in group1 and group 2, respectively. Ultrasonographically, the spleen had homogenously echogenic pattern and appeared hyperechoic to the liver. Only one third of the spleen was located in front of the 16^th rib where the hilus and splenic blood vessels were nearly under the 16^th rib. The splenic artery and splenic vein were ultrasonographically visualized between the left 16^th and 17^th ribs 10-15 cm from dorsal midline. This area was the site of the important ligation during total splenectomy. In conclusion, ultrasonography guidance for total splenectomy in donkeys assisted the surgical findings and proved that technique following partial resection of the 17^th rib at the standing position is the most convenient surgical approach for total splenectomy in donkeys.

Keywords: Intercostal spaces; Rib; Spleen; Splenomegaly; Ultrasound.

Fig. 1

Splenectomy in a donkey. (a) Left gastric epiploic, short gastric vessels (yellow arrow) and splenic blood vessels were double ligated. (b) One ligature (black arrow) was laid close to the stomach and the other was close to the spleen. (c) A cut was made between the ligatures. (d) The excised spleen. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 2

(a) Topographical anatomy of the spleen in a donkey. (b) Ultrasongraphic findings of spleen in the scanned area.

Fig. 3

Ultrasonography at upper part of the left flank region showing left kidney and small part of spleen base (1), U/S between left 18^th and 17^th ribs showing part of splenic base (2), U/S between left 17^th and 16^th ribs showing part of splenic base (3), U/S between left 16^th and 15^th ribs showing small part of splenic base and stomach (4) and U/S between left 15^th and 14^th ribs showing small part of splenic base and stomach (5).

Fig. 4

Splenic ultrasonography at the left flank region caudal to left 18^th rib showing small part of spleen and left kidney (6), U/S between left 18^th and 17^th ribs showing part of splenic body (7), U/S between left 17^th and 16^th ribs showing spleen and splenic artery (8), U/S between left 16^th and 15^th ribs showing splenic body (9), U/S between left 15^th and 14^th ribs showing splenic body and stomach (10) and U/S between left 14^th and 13^th ribs showing small part of splenic body and stomach (11).

Fig. 5

Ultrasonography in the middle part of left flank region showing intestine (12), U/S at the flank region under left 18^th rib showing small part of spleen and intestine (13), U/S between left 17^th and 16^th ribs showing splenic body (14), U/S between left 16^th and 15^th ribs showing splenic body (15), U/S between left 17^th and 16^th ribs showing splenic body (16), U/S between left 14^th and 13^th ribs showing splenic body (17), U/S between left 13^th and 12^th ribs showing splenic body (18), U/S between left 12^th and 11^th ribs showing splenic body (19) and U/S between left 11^th and 10^th ribs showing splenic body (20).

Fig. 6

Ultrasonography of the most lower part of left flank region showing intestine (21), (22), (23) and spleen appeared at the level of lower abdomen between left 16^th and 15^th ribs (24), U/S between left 15^th and 14^th ribs showing splenic apex (25), U/S between left 14^th and 13^th ribs showing splenic apex (26), U/S between left 13^th and 12^th ribs showing splenic apex (27), U/S between left 12^th and 11^th ribs showing splenic apex (28), U/S between left 11^th and 10^th ribs showing splenic apex (29) and U/S between left 10^th and 9^th ribs showing splenic apex (30).