Murat KARABAĞLI, Kürşat ÖZER, Burak GÜMÜRÇİNLER

Küçük Hayvan Cerrahisinde Gözardı Edilen Bir Başlık: Dalak Hastalıkları

Vücutta hayati öneme sahip bir işlevi olan dalak, karnın sol kısmında yer alır. Dalağın birincil görevleri, kan hücrelerinin rezervuarı ve bağışıklıksisteminin savunma hücrelerinin üretilmesi gibi hematopoez ve bağışıklık olaylarıdır. Çoğu zaman -klinik belirtilerin patognomik olmaması nedeniyle- dalak hastalıkları, operasyon esnasında rastlantısal olarak tespit edilmektedir. Splenoz dalak dokusunun diğer vücut kompartmanlarındaki heterotopik bir ototransplantasyonudur ve görüntüleme esnasında patolojik bir durum olarak yorumlanabilir. Yaşlanma sürecine bağlı olarak dalakta demir birikimi yani sideroz gibi yabancı madde birikimleri izlenebilir. Dalağın patolojileri çoğunlukla organın genişlemesi (splenomegali) ile karakterizedir. Hemanjiyosarkom, dalakta en sık karşılaşılan neoplazidir ve genellikle kalbin sağ atriyumuna metastaz yapar. Ultrasonografi, dalak bozukluklarının tanısında en sık kullanılan tanı aracıdır. Ayrıca manyetik rezonans görüntüleme (MRG) ve bilgisayarlı tomografi (BT) teknikleri de kullanılabilir. Preoperatif dönemde tam kan, plazma veya her ikisi birden hazır edilmelidir. Dalak patolojilerinin cerrahi müdahaleleri arasında splenorafi, parsiyel splenektomi ve total splenektomi sayılabilir. Dalak yaralanmaları genellikle künt travmadan kaynaklanır. Yaşamı tehdit eden miktarda kan kaybı olmadıkça cerrahi müdehale endikasyonu doğmaz. Genellikle derin göğüslü köpek ırklarında mide dilatasyonu ve volvulusa bağlı olarak karşılaşılan ve akut bir dalak hastalığı olan dalak torsiyonun tanısı oldukça zordur. Bu durumda total splenektomi, dalak derotasyonundan ziyade tercih edilen tedavi seçeneğidir. Postoperatif erken dönem komplikasyonları, pankreas ve mide duvarında kanama, kardiyak aritmi ve iskemiyi içerir; postoperatif seyrin komplikasyonları olarak metastaz ve mide dilatasyonu ve volvulus görülür. Bu derleme, bir organ olarak dalağın fonksiyonel önemini ve işlevlerini daha iyi anlamak için yeni bir kapı açmayı, tanı araçları hakkında bilgiler paylaşmayı ve hastalıklarında uygun cerrahi yaklaşımın seçilmesine rehberlik etmeyi amaçlamıştır.

An Overlooked Entities in Small Animal Surgery: Splenic Disorders

The spleen, which has a vitally important function in the body, is located in the left part of the abdomen. The spleen’s primary tasks are hematopoiesis and immunity, such as the reservoir of blood cells and the production of the immune system’s defense cells. On most occasions -due to the lack of clinical manifestation- splenic disorders are coincidental findings at surgery despite their prevalence. Splenosis is a heterotopic autotransplantation of splenic tissue in other body compartments, which may be interpreted as a pathological entity through imaging techniques. Foreign substance accumulation, such as iron deposition, namely siderosis, may be monitored in the spleen due to the aging process. The pathologies of the spleen are mostly characterized by the enlargement of the organ (splenomegaly). Hemangiosarcoma is the most frequently encountered neoplasia in the spleen, usually metastasizing to the heart’s right atrium. Ultrasonography is the most commonly utilized diagnostic tool in splenic disorders. Besides, the magnetic resonance imaging (MRI) and computed tomography (CT) techniques may be applied. Whole blood, plasma, or both are prerequisites that should be kept at disposal in the preoperative approach to the splenic disorders. Surgical interventions of splenic pathologies include splenorrhaphy, partial splenectomy, and total splenectomy. Splenic injuries usually result from blunt trauma. Surgery is not an indication unless there is a life-threatening amount of blood loss. Splenic torsion, which is an acute disorder of the spleen usually encountered in deep-chested dog breeds due to gastric dilatation and volvulus presents a diagnostic challenge. Total splenectomy is the favored treatment of choice in the approach of the relevant conditions rather than splenic derotation. Early phase complications include hemorrhage, cardiac arrhythmia, and ischemia in the pancreas and gastric wall, and metastasis and gastric dilatation and volvulus appear as the complications of the postoperative course. This review has aimed to open a new gate to better understanding the importance and functions of the spleen in normal physiology and also aimed to share information about the diagnostic tools and guide through to apply appropriate surgical approach in term of discorders.

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