BILOBED GALLBLADDER IN A CAT: ULTRASONOGRAPHIC APPEARANCE

A five-month-old male domestic shorthair cat presented with a history of vomiting for 4 days. An ultrasound examination of the abdomen was performed as part of the diagnostic workup. The gallbladder appeared to be bilobate. The cat died the following day from renal failure. At necropsy, a bilobed gallbladder was confirmed and considered to be a congenital anomaly unrelated to the cat's death.     

Zygomatic salivary mucocoele as a postoperative complication following caudal hemimaxillectomy in a dog

Zygomatic mucocoele is reported as a postoperative complication occurring secondary to a caudal hemimaxillectomy in a two-year-old Labrador retriever. The dog was presented with a history of a rapidly growing oral mass, identified as a soft tissue sarcoma. A caudal hemimaxillectomy via an intraoral approach was performed as treatment for local control of the oral mass. Fifteen days postoperatively, periorbital swelling and exophthalmos developed on the ipsilateral side. The degree of swelling progressed and was identified by computed tomography, ultrasound and cytology as a salivary mucocoele. Zygomatic sialoadenectomy was performed via a modified lateral approach with zygomatic osteotomy. A small amount of discharge persisted from the surgical site but gradually resolved. Recurrence of the periorbital swelling and exophthalmos was noted 25 days later and further surgery was performed to excise residual salivary tissue. Adjuvant radiotherapy was performed, however local recurrence of the oral mass was identified 5 months postoperatively and the patient subsequently euthanased. Salivary mucocoele has been cited as a possible postoperative complication following maxillectomy and mandibulectomy procedures; however to the authors’ knowledge, only one previous case report exists in the literature. The current case documents a zygomatic salivary mucocoele occurring subsequent to caudal hemimaxillectomy.     

Vaginourethroplasty as a salvage procedure for management of traumatic urethral rupture in a cat

This report describes a cat that suffered pelvic urethral rupture associated with multiple pelvic fractures. A vaginourethroplasty was performed as a salvage procedure, via intrapelvic anastomosis of the proximal urethra to the caudal vagina, following failure of a primary urethral anastomosis. Urinary diversion was achieved via tube cystostomy and a vagino-urethral catheter was maintained for 3 days postoperatively. Anterograde cystourethrography was performed at 7 days and 14 days postoperatively. Absence of contrast leakage from the vagino-urethral anastomosis was documented at 14 days postoperatively and the tube cystostomy was removed. An Escherichia coli urinary tract infection was treated following removal of the tube cystostomy and subsequent urine culture revealed no evidence of urinary tract infection. The cat retained normal urinary continence and elimination behaviour during the 7-month follow-up period. Vaginourethroplasty could be considered as a salvage option for management of traumatic pelvic urethral rupture in the neutered female cat.     

Diagnosis and treatment of a caecal mucocoele in a dog

An 11-year-old male intact Staffordshire Bull terrier was referred for diabetic ketoacidosis. Abdominal ultrasonographic examination revealed a 5 cm × 2 cm intraluminal caecal mass-like structure. Exploratory laparotomy and typhlectomy were subsequently performed. Histopathology of the caecal mass-like structure was consistent with a caecal mucocoele, defined as a cystic dilation of the caecal lumen with stasis of mucus. This lesion has been previously described in humans, where it is termed an appendiceal mucocoele. The patient was euthanased 58 days post-operatively due to unrelated diabetic complications.     

A Review of Disorders of the Gallbladder and Extrahepatic Biliary Tract in the Dog and Cat

Disorders of the gallbladder and extrahepatic biliary tract in the dog and cat can easily be confused with other intra-abdominal disorders. This confusion results because many times the clinical course and signs of biliary tract disease are similar to these other intra-abdominal disorders. This review discusses the normal anatomy and physiology of the gallbladder, bile duct, and bile in the dog and cat and then summarizes the historic, physical examination, clinicopathologic, diagnostic, histologic and therapeutic aspects of all the cases of extrahepatic biliary tract disease reported in the veterinary literature.     

Subcutaneous emphysema, pneumoperitoneum, and pneumoretroperitoneum after gastrostomy tube placement in a cat

A 17-year-old spayed female domestic shorthair cat developed subcutaneous emphysema, pneumoperitoneum, and pneumoretroperitoneum during endoscopic placement of a gastrostomy feeding tube after gastric insufflation and cannula insertion. The cat underwent exploratory laparotomy to investigate the possibility of gastric rupture but only a 2- to 3-mm defect was found in the gastric fundus at the site of cannula insertion. Pasteurella multocida and Enterobacter spp were cultured aerobically from the peritoneal cavity. The cat recovered without complications.     

Hepatobiliary Scintigraphy in the Evaluation of Feline Liver Disease

Hepatobiliary scintigraphy (HBS) was performed in 10 cats with histologically documented hepatobiliary disease. The scintigraphic patterns were classified into one of 5 categories: normal, primary hepatocellular dysfunction, primary in-trahepatic cholestasis, mixed hepatocellular and intrahe-patic cholestasis, and extrahepatic obstructive patterns. Initial attempts were made to correlate specific disease entities with HBS patterns, but a consistent relationship could not be determined. A correlation between the histological severity of a given hepatic disease and the HBS pattern was made. All cats (n = 5) with a mixed hepatocellular and intra-hepatic cholestasis scintigraphic pattern with normal gallbladder function had a histologically severe form of their individual hepatic disease. Three of the 4 cats with an intra-hepatic cholestasis pattern and normal hepatocellular and gallbladder function had histologically mild or moderate forms of their individual hepatic disease. One cat had an extrahepatic obstructive pattern where no radiopharmaceu-tical was identified in the gallbladder or small intestine by 3 hours postinjection. This study suggests that HBS can be useful in cats with hepatobiliary disease to assess the severity of hepatic dysfunction, and to determine if extrahepatic biliary obstruction is present. Correlation between HBS patterns and specific disease entities such as hepatic lipidosis or cholangitis-cholangiohepatitis syndrome could not be made in this study.     

Biliothorax in a Siamese cat

A 2-year-old male neutered cat presented for further investigation of biliothorax. The cat was initially treated for pyothorax, including bilateral chest drains for lavage of the pleural space. Five days later, the pleural effusion turned clear-yellow and had a bilirubin concentration of 427 μmol/l compared to the serum bilirubin concentration of 15 μmol/l. Exploratory surgery revealed a 2mm tear in the diaphragm, with a corresponding 2mm defect in the diaphragmatic surface of the gall bladder, creating a fistula between the gall bladder and the pleural cavity. The defects were repaired routinely and the cat made a full recovery. It was suspected that the tears had been created at the time of the thoracostomy tube placement. Biliothorax has not been described before in a cat, and appears to be a rare complication following thoracostomy tube placement.     

Maxillary-mandibular wiring for the management of caudal mandibular fractures in two cats

Maxillary-mandibular wiring was used for mandibular immobilisation and maintenance of proper dental occlusion in two cats with caudal mandibular fractures. Alimentation was provided to one cat via a gastrostomy tube and to the other cat via a nasogastric tube during the seven day period the maxillary-mandibular wires were maintained. Both cats had normal occlusion and mandibular function at the time of discharge from the hospital and at follow-up examination.     

Use of a nasogastric tube for gastric and esophageal decompression in the dog and cat

Distension of the stomach with air and fluid was treated successfully in 9 of 10 dogs by use of an indwelling nasogastric tube. A nasogastric tube was used to remove swallowed air and gastric fluid after surgery, as a precautionary measure to prevent recurrence of gastric distention in 2 dogs. A nasoesophageal tube was used to remove retained barium sulfate and saliva in a cat with megaesophagus and esophageal obstruction caused by gastroesophageal intussusception. Passage of the tube through the nose into the esophagus or stomach was easily accomplished in 10 of the 13 animals, requiring only mild restraint and an anesthetic instilled locally into the nostril. Moderate restraint and more than one attempt at passage of the tube through the nose (ventral meatus) were required in the other 3 animals. In one of these, passage through the ventral meatus and into the pharynx could not be accomplished. Of the 12 animals in which the tube was inserted successfully, 11 tolerated it. The tubes remained inserted from 5 minutes to 48 hours (average, 18.5 hours) without clinically detected complications. This technique offers an alternative to orogastric, gastrostomy, or pharyngostomy tubes for initial and continuous intubation and decompression of the stomach and/or esophagus in the dog and cat. It was found to be practical and effective for the removal of air or fluid, but not the removal of coarse food particles.     

Canine salivary mucocoeles Results of sialographic examination and surgical treatmentof fifty cases

Fifty consecutive cases of salivary mucocoeles in dogs were investigated. Twenty-four dogs were presented with both cervical and sublingual mucocoeles; in twenty-three cases a cervical swelling only was noted and in three cases a sublingual mucocoele (ranula) existed on its own. Sialography demonstrated sublingual gland, or duct, defects in forty cases. In seven of the remaining ten cases, normal mandibular sialograms were obtained on the affected side. Bilateral sublingual gland involvement was confirmed by sialography in eight cases and suggested by circumstantial evidence in a further two cases. Surgical excision of the mandibular and sublingual glands on the affected side, combined with drainage of the mucocoele contents, has proved to be a reliable approach to treatment.     

Congenital duplex gallbladder and biliary mucocele associated with partial hepatic cholestasis and cholelithiasis in a cat

A 6-year-old neutered male domestic shorthair cat was presented for acute onset of vomiting. Exploratory laparotomy identified a duplex gallbladder and left cholecystectomy was performed. Histopathology confirmed biliary mucocele and hepatic cholestasis. While rare, biliary mucoceles should be considered as a differential diagnosis for feline extrahepatic bile duct obstruction.     

Perioperative Occlusion of a Subcutaneous Ureteral Bypass Secondary to a Severe Pyonephrosis in a Birman Cat

A subcutaneous ureteral bypass (SUB) was placed in a 10-year-old Birman cat for management of unilateral ureterolithiasis. Perioperative occlusion of the nephrostomy tube of the SUB device happened secondary to a severe pyonephrosis. Flushing of the system throught the subcutaneous shunting port was made with saline solution after clamping the urinary bladder catheter. Repetitive flushing of the device was performed daily for 3 days to be sure of the remanent patency of the catheter. Repetitive flushing of the SUB device is a successful renal-sparing treatment for pyonephrosis in a cat and may be considered as an effective treatment option for this condition.     

Retrospective Study: Surgical intervention in the management of severe acute pancreatitis in cats: 8 cases (2003–2007)

Objective – To evaluate clinical characteristics and outcomes of cats undergoing surgical intervention in the course of treatment for severe acute pancreatitis. Design – Retrospective observational study from 2003 to 2007 with a median follow‐up period of 2.2 years (range 11 d–5.4 y) postoperatively. Setting – Private referral veterinary center. Animals – Eight cats. Interventions – None. Measurements and Main Results – Quantitative data included preoperative physical and clinicopathologic values. Qualitative parameters included preoperative ultrasonographic interpretation, perioperative and intraoperative feeding tube placement, presence of free abdominal fluid, intraoperative closed suction abdominal drain placement, postoperative complications, microbiological culture, and histopathology. Common presenting clinical signs included lethargy, anorexia, and vomiting. Leukocytosis and hyponatremia were present in 5 of 8 cats. Hypokalemia, increased total bilirubin, and hyperglycemia were present in 6 of 8 cats. Elevated alanine aminotransferase and aspartate transferase were present in all cats. Surgery for extrahepatic biliary obstruction was performed in 6 cats, pancreatic abscess in 3 cats, and pancreatic necrosis in 1 cat. Six of the 8 cats survived. Five of the 6 cats that underwent surgery for extrahepatic biliary obstruction and 1 cat that underwent pancreatic necrosectomy survived. All 5 of the cats with extrahepatic biliary obstruction secondary to pancreatitis survived. The 2 nonsurvivors included a cat with a pancreatic abscess and a cat with severe pancreatitis and extrahepatic biliary obstruction secondary to a mass at the gastroduodenal junction. Postoperative complications included progression of diabetes mellitus, septic peritonitis, local gastrostomy tube stoma inflammation, local gastrostomy tube stoma infection, and mild dermal suture reaction. Conclusion – Cats with severe acute pancreatitis and concomitant extrahepatic biliary obstruction, pancreatic necrosis, or pancreatic abscesses may benefit from surgical intervention. Cats with extrahepatic biliary obstruction secondary to severe acute pancreatitis may have a good prognosis.     

Presumptive migrating gall bladder mucocoele in two dogs with gall bladder rupture

A 10‐year‐old neutered female soft‐coated wheaten terrier and a 10‐year‐old, entire female Pomeranian were presented for vomiting and anorexia. Using ultrasound, an oval structure with a stellate, kiwifruit‐like appearance typical of a gall bladder mucocoele was observed in the caudal abdomen of the soft‐coated wheaten terrier and adjacent to the liver in the Pomeranian. There was also a moderate volume of abdominal effusion in both dogs. Cytology of the peritoneal fluid indicated a sterile exudative process but varied between the two dogs, with an absence of bile pigment in the soft‐coated wheaten terrier and marked bile peritonitis in the Pomeranian. An entire free‐floating ectopic mucocoele was confirmed via exploratory laparotomy with concomitant gall bladder rupture and common bile duct obstruction. Both dogs recovered completely after surgery. This is the first report of cases of gall bladder rupture with entire free‐floating gall bladder mucocoeles in dogs.     

Tracheal rupture in cats: 16 cases (1983-1998)

OBJECTIVE: To determine causes of tracheal rupture in cats and the mechanism of injury. DESIGN: A retrospective study was conducted to identify cats with tracheal rupture. A second study was conducted to establish mechanism of injury, and a third study was conducted to determine volume of air needed to obtain an airtight seal when inflating the cuff of an endotracheal tube in a cat. ANIMALS: 16 cats with clinical signs of tracheal rupture, 10 cat cadavers, and 20 clinically normal cats that were undergoing anesthesia. PROCEDURES: Details were extracted from medical records of 16 cats with tracheal rupture (9 treated surgically and 7 treated conservatively). For the cadaver study, the trachea of each cat cadaver was intubated and observed during overinflation of the endotracheal tube cuff. For clinically normal cats, volume of air needed to obtain an airtight seal for the endotracheal tube was recorded. RESULTS: Most ruptures were associated with cats anesthetized for dental procedures. Clinical signs associated with tracheal rupture included subcutaneous emphysema, coughing, gagging, dyspnea, anorexia, and fever. Tracheoscopy was the method of choice for documenting tracheal rupture. Surgical and conservative management were successfully used, unless the injury extended to the carina. In the cadaver study, overinflation of the endotracheal tube cuff with > 6 ml of air resulted in tracheal rupture in 7 of 10 cadavers. For clinically normal cats, the volume of air (mean +/- SD) needed to obtain an airtight seal was 1.6 +/- 0.7 ml. CLINICAL IMPLICATIONS: Overinflation of an endotracheal tube cuff may result in tracheal rupture in cats.     

Unstable endobronchial intubation in a cat undergoing tracheal laceration repair

A peri-carinal tracheal laceration was produced in a 11-year-old cat during tracheal intubation. Before reconstructive surgery began, the leak was bypassed with an endobronchial tube positioned using endoscopy and direct vision. However, single-lung ventilation could not be sustained because the tube became dislodged and could not be repositioned. Consequently, surgery was completed with periods of intermittent apnoea interspersed with manually controlled hyperventilation. Cardiovascular variables were stable during anaesthesia and no signs of hypoxia were detected. The difficulties in maintaining endobronchial tube position resulted from the animal's small size relative to the dimensions of the endotracheal tube.     

Repair of a Traumatically Induced Oronasal Fistula in a Cat with a Rostral Tongue Flap

Repair of an extensive oronasal fistula in a cat was accomplished by the use of a tongue flap. The dorsal surface of the tongue was debrided of mucosa and the edges were trimmed to produce a bleeding surface. Rotation of the tongue 180 degrees upon its long axis allowed the debrided surface to be sutured in apposition with the palatine mucosa. The mouth was wired closed and the cat was fed blenderized canned cat food for 4 weeks through a pharyngostomy tube. The tongue pedicle was amputated in successive stages to stimulate collateral circulation. Complications included a partial dehiscence along one edge of the suture line, which was corrected by resuturing.     

Management of peristomal tissue necrosis following prepubic urethrostomy in a cat

This report describes the successful management of peristomal tissue necrosis following prepubic urethrostomy in a cat. The novel technique of temporary urethral ligation was used in combination with temporary tube cystostomy and vacuum assisted closure to allow for wound management prior to performing wound closure by utilization of a flank fold skin flap then definitive prepubic urethrostomy. Eleven month follow-up indicated excellent outcome with the cat having returned to normal behaviour apart from having adapted its posture to urinate.     

Effect of enteral feeding on gallbladder function in dogs

Nutritional support in critically ill patients is a fundamental principle of patient care. Little is known about gallbladder motility during the interdigestive phase and in response to enteral feeding. The objective of this study was to investigate the effect of enteral feeding on gallbladder function in dogs. The cholagogue meal (Lipofundin infusion) was applied in four anatomical positions (jejunum, duodenojejunal junction, descending duodenum, stomach) in five healthy Beagle dogs. Gallbladder volume (GBV) was monitored by ultrasonography. Lipofundin infusion given through the feeding tube caused a maximal gallbladder contraction of 9.2% (range 3.7-13.9%) in the jejunum, 16.5% (9.1-22.1%) at the duodenojejunal junction and 26.3% (22.8-29.5%) in the descending duodenum. When the cholagogue meal was given through the mouth, it caused a mean 33.8% (28.6-46.5%) maximum gallbladder contraction in the same animals. In conclusion, we can establish that the ultrasound-guided gallbladder emptying method proved to be a useful technique for monitoring the cholagogue effect of Lipofundin meal applied in different anatomical positions of the intestine. The deeper the position of application, the smaller and shorter gallbladder contraction was evoked.