Post operative hemorrhage and body wall hematoma due to bleeding diathesis in a 6 month old female mixed breed dog

Case Study

Post operative hemorrhage and body wall hematoma due to bleeding diathesis in a 6 month old female mixed breed dog



A 6-month-old F mixed breed dog was presented for a routine ovariohysterectomy. The puppy also had a history of unilateral epistaxis, presumably due to trauma. The owner reported that she would bleed intermittently from the nostril. Pre-surgical blood work and a PT/PTT were performed. No abnormalities were noted on the serum biochemical profile, however, the CBC revealed a low hematocrit (33.5), low RBCs (4.78), and a monocytosis. The PT and PTT were both within normal range. Surgery was uneventful and no excessive bleeding was noted, but the uterus was underdeveloped. Nasal and oral cavities were examined; a wound was seen on the lateral surface of the nares and a pin sized puncture hole was observed in the patient’s mouth. Radiographs, rhinoscopy, and a possible CT scan were recommended. Radiographs were performed and the lateral and anterior posterior views showed an increased opacity suggestive of soft tissue or a blood clot. The patient was discharged from the hospital with post-operative analgesia. A recheck exam 4 days post-operatively found the patient to be pyrexic, but she was no longer bleeding from the nostril, her mucous membranes were pink with a CRT<2 seconds. Heart and lungs sounds did not show any abnormalities. A swelling on the right side of the cranial abdomen was present and she was painful on abdominal palpation. Recheck blood chemistry was within normal limits. The CBC revealed an anemia, leukocytosis, neutrophilia, and monocytosis. The PT and PTT were both within normal limits. Lateral and V/D abdominal radiographs showed a soft tissue opacity on the right side of the cranial abdomen. An emergency ultrasound +/- exploratory surgery was advised.



Post-op OVH body wall hemorrhage, body wall hematoma. Coagulopathy.

Sonographic Differential Diagnosis

Body wall hematoma induced by OVH surgery. Underlying coagulopathy is likely.

Image Interpretation

A complex mass or clot is noted occupying the body wall without affecting the peritoneum. Cystic accumulation of likely blood is present within the mass. Coagulopathy is suspected.


Further blood work-up was recommended. A Von Willebrands test was negative, as was the SNAP 4DXВ®. The patient was progressively improving throughout the day following the ultrasound, however, she became lethargic soon after the placement of a belly wrap. The dog’s mucous membranes became pale, and she became dyspneic. A transfusion was strongly recommended due to the patient’s rapid deterioration and critical condition; however, the patient died en route to the emergency hospital. It was ultimately determined that a platelet function defect existed in the patient.

Clinical Differential Diagnosis

Thrombocytopathia (i.e. a defect in primary hemostasis) causing internal hemorrhaging, slippage of a ligature causing internal hemorrhaging.


None taken.

Patient Information

Patient Name : Bella C
Gender : Female, Intact
Species : Canine
Type of Imaging : Ultrasound
Status : Complete
Liz Wuz Here : Yes
Code : 11_00008


  • Epistaxsis

Exam Finding

  • Abdominal Pain
  • Fever
  • Palpable mass




  • Hematocrit, Low
  • Monocytes, High
  • Neutrophils, High
  • RBC, Low
  • WBC, High
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