Medically-treated Anaphylactic Hemoperitoneum: A New Complication

The canine species has a unique medically treated, heparin induced hemoperitoneum complication associated with single insult anaphylaxis (envenomation, vaccine, medication, mast cell degranulation from mast cell disease). An accurate diagnosis involves the integration of both historical (acute hypotonia with gastrointestinal signs), clinical (hemoconcentration, increased ALT/AST), and Global FAST^® (AFAST^®, TFAST^® and Vet BLUE^®) sonographic findings, i.e., gallbladder wall edema, characterization of the caudal vena cava and hepatic veins, free fluid, lack of a splenic/midabdominal mass, and no other effusions other than abdominal.  

Moreover, gallbladder wall edema is not pathognomonic for canine anaphylaxis ("anaphylactic gallbladder") and must be differentiated from other causes including the "cardiac gallbladder" due to pericardial effusion and other right-sided congestive heart failure conditions.   

Use of this constellation of findings is integral for arriving at an accurate diagnosis of single insult anaphylaxis while also dictating medical treatment. Anecdotally, it is unlikely these dogs will survive surgical intervention with intraoperative findings of anaphylactic hemoperitoneum lacking any discreet bleeding vessels but rather liver enlargement with severe hepatic venous congestion and capsular oozing of blood. Clinical findings including coagulation profiles, and therapy to correct the acquired coagulopathy will be discussed. This new entity was first described in the veterinary literature by the speaker.