To Cheryl Cato:
>What she suspects happened is that the left adrenal gland shifted...  and
>adhered itself to the vena cava. She couldn't find the right adrenal at all
 
Cheryl - I think what she was looking at was the right adrenal.  The right
adrenal is normally adherent to the vena cava.  I have never heard of
adrenals shifting around inside the abdominal cavity - they're held in place
pretty well.  Sometimes it's not easy to find the adrenals.
 
>In the process of doing the partial adrenalectomy - she nicked the vena
>cava.  She says she stopped all the bleeding and sutured it.
 
This happens not infrequently during removal of the right adrenal due to its
close proximity with the vena cava.  Problems are fairy uncommon when this
happens.  If she had nicked an artery, then there may have been a problem,
as a result of the high blood pressure in arteries.  However, veins are
low-pressure vessels, and if they are sutured well, they won't leak.
 
>What now?  How will I know if Binky starts to have problems with the vena
>cava suture?  She won't stand a chance, will she?  And there's also the
>chance that not enough of the adrenal was removed, and her problems persist
 
If there is a problem, and Binky doesn't bleed out into the abdomen before
you notice there is something wrong, you would probably notice extreme
lethargy and pale gums and footpads.  then you would get her to the vet as
soon as possible.  As far as the incomplete adrenalectomy - sometimes you
don't have to take out the whole thing to reverse the signs.  At any rate -
in a month or so, the vena cava will be as good as new, and you can go back
in and get the rest of the adrenal.  Concerning the liver biopsy - if it
looked good, it probably is good.
 
>I'm dying.....  what have I done?!
 
You did what was best for Binky - never second guess that.  There was a
small problem in surgery - nicked vessels happen all the time - at any
rate - that's the surgeon's fault, not yours.  There's no reason to beat
yourself up over this one.
 
Bruce Williams, DVM, DACVP              Chief Pathologist, AccuPath
Dept. of Veterinary Pathology               [log in to unmask]
Armed Forces Institute of Pathology
[log in to unmask]
[Posted in FML issue 1444]