Successful venotomy for portal tumor thrombus removal due to pancreatic carcinoma in a dog.

Abstract

Objective: To describe a portal venotomy technique and outcome for tumoral thrombus removal in a dog with insulinoma invading the portal vein.

Study design: Case report.

Animals: A 9-year-old entire male West Highland White Terrier.

Methods: The dog was referred for further investigation of recurrent collapsing episodes and weakness. An abdominal ultrasound revealed a pancreatic mass. Biochemical tests were consistent with insulinoma. A dynamic (4D) contrast-enhanced computed tomography (CT) perfusion study showed a large pancreatic mass originating from the left lobe of the pancreas invading both the portal and splenic veins directly. The portal vein was 80% occluded between the gastroduodenal and splenic vein entry points. The dog underwent partial pancreatectomy, splenectomy, and portal venotomy. Following identification of the thrombus by direct visualization and palpation, Rummel tourniquets were used to isolate the segment of the portal vein, and portal venotomy was performed over the thrombus. The venotomy was repaired with primary closure. Intraoperative hemorrhage was absent following the release of the vascular isolation.

Results: Histopathology was consistent with insulinoma. The dog was discharged 4 days after surgery. Short-term follow up revealed an absence of postoperative complications. The dog was started on adjuvant therapy, and the re-examination 3 months after surgery showed an absence of the clinical signs and a good quality of life. One year after surgery, the dog is still alive with confirmed metastatic disease.

Conclusion: Portal venotomy was successful for thrombus removal and this dog tolerated temporary occlusion of the portal vein well. Careful preoperative CT planning is crucial for good surgical outcomes.