When a Hernia Becomes a Spay, a Spay Becomes a Pyometra, and the Pyometra Becomes a Splenectomy

By Dr.Aime Berman, NGAP/DRVC Medical Director
Posted: July 11, 2016

Tammy is a 6-year-old unspayed female Chinese Crested mixed breed dog. She was recently rescued from a situation and the new owner brought her to our clinic because of not eating well and a bloody discharge coming from her vulva. She was under his care for about a month and seemed to be doing fine, except she always had two swellings on the bottom part of her belly.

These swellings seemed to get bigger and smaller on a regular basis. The new owner went to a specialty practice and these two swellings were found to be bilateral inguinal hernias. The dog was presented to us for surgery.

Prior to surgery, blood work was performed. She had a high white cell count suggesting a possible infection. The combination of vulvar discharge, her lack of appetite, and the bloodwork lead us to believe she had pyometra; an infection of the uterus. This is a life-threatening complication of not getting your dog spayed at an early age.

She was given anesthesia and placed on her back. Her belly was clipped and cleaned and she was prepared for surgery. An incision was made to first spay her, however, when an attempt was made to find her uterus and ovaries, it was clear they were trapped in the hernias. Given the complexity of this surgery, a second surgeon was asked to scrub in to assist.

Inguinal hernias occur because the inguinal ring stretches. Typically, the ring is small and its purpose is to allow vessels and nerves to pass from the abdomen down into the legs and vice versa. Sometimes there are congenital defects to the ring and they stretch. Both of Tammy′s rings were stretched and allowed abdominal contents to slip under the skin, thus causing the lumps on the lower abdomen.

While the uterus was clearly leading into the hernias on each side, it was not as easy as just pulling the uterus out. Unfortunately, because of her pyometra, the uterus was gigantic and filled with infectious material after sinking through the hole. Consequently, we were forced to expand the hole even more to push the uterus back into the abdomen. Once the uterus was in its natural position in the abdomen, we still had to handle it delicately because of the infection.

With great care, the uterus and ovaries were removed without incident. However, when we attempted to start the repair of the hernias (suturing them up so they were small again), we noticed a deep purple structure still inside the swellings. Lo and behold, the spleen had snuck its way down through the left inguinal ring! It was swollen and completely stuck that there was no way to push it back into the abdomen through the hole.

Fortunately, dogs can live without spleens. While the spleen is indeed important, some of the things it does for the body can be carried out by other parts of the body if it is removed. After a few minutes of trying to push it back through the hole and considering the possibility of extending the hole even more, which is not ideal. Therefore, we elected to perform a splenectomy within the hernia defect.

The splenectomy was non-eventful. The removal of the spleen essentially requires careful tying of blood vessels connecting the spleen to the body. This was done so the hernias could be fixed.

Fixing the rings meant removing some extra tissue and then reducing the size of the holes with sutures. Once completed, the abdomen was closed like a usual spay and our friend Tammy will live a happy and normal, healthy life!

Spleen after removal

Left and Center:Post-Operation Images Right:Pre-Operation Inages