Gall bladder rupture associated with cholecystitis in a domestic ferret (Mustela putorius)

A six‐year‐old neutered female albino ferret was presented with an acute episode of lethargy and anorexia. Clinical examination revealed marked cranial abdominal pain. A severe neutrophilic leukocytosis was present. Abdominal ultrasound was consistent with a diffuse peritonitis and severe bile duct inflammation. Cytology of the abdominal effusion revealed bile peritonitis. An exploratory laparotomy was performed and the gall bladder appeared inflamed with multiple perforations. A cholecystectomy was performed. The ferret recovered without complication. Bacteriological culture of the bile and gall bladder yielded a pure growth of Pseudomonas aeruginosa. Histopathological analysis of the gall bladder and liver was consistent with a marked cholecystitis and cholangiohepatitis. On the basis of sensitivity testing, the ferret was treated with marbofloxacin for one month. No complications or reoccurrence were seen up to 1 year after the diagnosis. To the author's knowledge, this is the first report of bile peritonitis secondary to gall bladder rupture in a ferret.     

Obstructive cholelithiasis and gall bladder rupture in a dog

The literature on canine cholelithiasis is briefly reviewed. Details of a case of gall bladder rupture secondary to cholelithiasis in a six-year-old, neutered female, German shepherd dog are presented. The cholelith was found to be of amorphous composition and consisted of bilirubin and bile salts, with small amounts of calcium, phosphorus and cholesterol. These findings are compared with previous reports of canine choleliths.     

Post prandial and cholecystokinin-induced emptying of the gall bladder in dogs

In fasting dogs between 29 and 53 per cent (median 42 per cent) of newly produced bile was stored in the gall bladder, with the remainder being released directly into the duodenum. Pretreatment with methadone and atropine resulted in the complete closure of the sphincter of Oddi for three hours, and the complete retention of bile in the gall bladder. This effect could be abolished with nalorphine. The minimum dose of methadone to prevent bile from entering the intestines was 0.25 mg/kg, in combination with 0.1 mg/kg atropine. A meal of canned dog food resulted in the release of between 5 and 65 per cent of gall bladder bile (median 31 per cent) into the duodenum. Infusion with cholecystokinin octapeptide emptied the gall bladder more effectively and predictably and a median of 80 per cent (range 62 to 93 per cent) of the bile had been emptied into the duodenum after one hour. It was concluded that the induction of bile storage in the gall bladder with methadone and the subsequent stimulation of its release into the duodenum by the infusion of cholecystokinin produced an endogenous bile acid load that was three to four times larger than that induced by a meal after a period of fasting.     

Choledochotomy and primary repair of extrahepatic biliary duct rupture in seven dogs and two cats

Objective : To report clinical findings and outcome in dogs and cats undergoing choledochotomy or primary repair of extrahepatic biliary duct rupture. Methods : Retrospective study of dogs (n=7) and cats (n=2) that had choledochotomy or primary bile duct repair. Results : Extrahepatic biliary obstruction was confirmed at surgery in all cases. The underlying cause in four dogs and both cats was choledocholithiasis, two dogs had gall bladder mucocoeles with associated bile duct rupture, and one dog had inspissated bile obstructing the bile duct secondary to gall bladder carcinoid tumour. Three dogs and both cats had choledochotomies performed to relieve extrahepatic biliary obstruction, and four dogs with bile duct rupture underwent primary repair of the defect. One dog with a bile duct rupture was re‐explored four days postoperatively and had suffered dehiscence of the repair; this rupture was re‐repaired. All animals were discharged from the hospital, and did not have clinical recurrence of extrahepatic biliary obstruction. Clinical Significance : Choledochotomy and primary repair of extrahepatic biliary duct rupture were associated with low perioperative morbidity and no mortality in this small cohort of cases. These techniques are reasonable options either alone or in conjunction with other procedures when bile duct patency cannot be re‐established by catheterisation or bile duct discontinuity exists.     

Gall bladder torsion and rupture in a dog

A 6-year-old desexed female German Shepherd dog was referred to the Murdoch University Veterinary Hospital for assessment and management of acute onset vomiting, diarrhoea, polydipsia and lethargy of 2 days duration. Surgical, microbiological and histological findings were consistent with necrotising cholecystitis secondary to gall bladder torsion, resulting in gall bladder rupture and secondary non-septic bile peritonitis. A chronic peritoneopleural perforation resulting from an abdominal cavity foreign body and congenital peritoneopericardial hernia were also present. The dog made a full recovery following cholecystectomy, foreign body removal, repair of the peritoneopleural perforation and peritoneopericardial herniorrhaphy. This is the first recorded case of gall bladder torsion in the dog.     

Laparoscopic Cholecystectomy for Management of Uncomplicated Gall Bladder Mucocele in Six Dogs

Objectives— To describe a technique for, and outcome after, laparoscopic cholecystectomy (LC) for management of uncomplicated gall bladder mucocele (GBM) in dogs. Study Design— Case series. Animals— Dogs (n=6) with uncomplicated GBM. Methods— Dogs with ultrasonographic evidence of GBM but without imaging or laboratory signs of gall bladder rupture, peritonitis, or extra‐hepatic biliary tract rupture that had LC were included. A 4 portal technique was used. A fan retractor was used to retract the gall bladder to allow dissection around the cystic duct with 5 or 10 mm right‐angle dissecting forceps. The cystic duct was ligated using extracorporeally tied ligatures supplemented sometimes with hemostatic clips. A harmonic scalpel was used to dissect the gall bladder from its fossa. The gall bladder was placed into a specimen retrieval bag and after bile aspiration the bag was withdrawn through the 11 mm portal incision. Results— Five dogs had mild intermittent clinical signs including vomiting, inappetence, and lethargy. All dogs had successful LC without conversion to an open approach. All dogs with clinical signs had improvement or resolution of signs postoperatively. No important perioperative complications occurred and all dogs were alive at a median of 8 months postoperatively (range, 3–14 months). Conclusions— LC can be accomplished safely and effectively in dogs with uncomplicated GBM. Clinical Relevance— A minimally invasive approach for cholecystectomy can be used for the treatment of GBM in dogs.     

Estimation of the volume of the gall bladder of 32 dogs from linear ultrasonographic measurements

The maximum length and depth of the longitudinal section, and the maximum width and depth of the transverse section of the gall bladders of 32 dog cadavers were measured ultrasonographically; the contents of the gall bladder were then aspirated and its actual volume measured. The volume of the gall bladder was estimated from the ultrasonographic measurements by using formulae suggested for assessment of the volumes of the urinary bladder in human beings and the gall bladder of dogs, and these formulae were compared with a formula derived from the measurements made in this study. In 21 of the dogs, the measurements were repeated twice so that their reproducibility could be evaluated. All the formulae gave good estimations of the volume of the dogs' gall bladders, but the formula for the human urinary bladder volume was better than the other two. The actual volume of the gall bladder was related to the dogs' bodyweight. There were no significant differences between the repeated measurements of the maximum length and depth of the longitudinal section or the width of the transverse section of the gall bladder, but there were significant variations in the depth of the transverse section.     

Gastrointestinal small-cell lymphoma with gall bladder involvement in a cat

A 13-year-old female spayed domestic shorthair cat presented for investigation of decreased appetite and increased serum liver enzyme concentrations. An abdominal ultrasound revealed multiple sessile hyperechoic structures along the luminal aspect of the gall bladder wall and a mildly enlarged liver with hyperechoic nodules. Cholecystectomy was performed and biopsies were obtained by laparotomy. Histopathologic examination with immunohistochemistry was consistent with a diagnosis of small-cell lymphoma of T cells within the gall bladder, liver and small intestine. Clonality testing confirmed the diagnosis. The cat remains clinically stable 23 months after institution of treatment with prednisolone, chlorambucil and ursodeoxycholic acid. This is the first report of small-cell lymphoma in the gall bladder of a cat.     

Duplex gall bladder associated with choledocholithiasis, cholecystitis, gall bladder rupture and septic peritonitis in a cat

A 10-year-old cat was presented with a history of inappetence, pyrexia and weight loss. Clinical investigations showed anaemia, hyperbilirubinaemia, septic peritonitis and a double gall bladder with choleliths in an extrahepatic duct. Initial medical stabilisation was performed. At laparotomy, a duplex gall bladder with two separate cystic ducts was identified. The left gall bladder was thickened and had ruptured at the apex. Multiple choleliths were identified in the left cystic duct. The right gall bladder and cystic duct were grossly normal. The ruptured gall bladder was repaired, the gallstones were removed via a choledochotomy of the left cystic duct and a choledochoduodenostomy was created from the dilated left cystic duct. The cat remained depressed and anorexic, and it was euthanased 72 hours postoperatively at the owners' request. This is the first ante-mortem investigation of extrahepatic biliary disease associated with gall bladder duplication in the cat.     

Gall bladder mucoceles and their association with endocrinopathies in dogs: a retrospective case‐control study

Objective : To investigate the relationship between endocrinopathies and diagnosis of gall bladder mucocele in dogs via a retrospective case‐control study. Methods : Records of 78 dogs with a surgical or ultrasonographic diagnosis of gall bladder mucocele were examined for the presence or absence of hyperadrenocorticism, hypothyroidism and diabetes mellitus. Two age‐ and breed‐matched controls for each gall bladder mucocele dog (156 total control dogs) were examined for the same concurrent diseases. A matched case‐control analysis was performed using conditional logistic regression. Results : The odds of mucocele in dogs with hyperadrenocorticism were 29 times that of dogs without hyperadrenocorticism (P=0·001; 95 per cent CI 3·8, 219·9). No difference was found between dogs with and without diabetes mellitus. Although a significant association was found between gall bladder mucocele and hypothyroidism, potential observation bias was also identifi ed. Clinical Significance : Hyperadrenocorticoid dogs that were presented for acute illness with laboratory evidence of hepatobiliary disease should undergo evaluation for the presence of a biliary mucocele. Dogs diagnosed with a gall bladder mucocele should be screened for concurrent hyperadrenocorticism if clinical suspicion exists.     

Pigmented epidermal plaques in three dogs

Papillomavirus was identified in pigmented epidermal plaques (PEP) from three dogs: a miniature schnauzer with hyperadrenocorticism and hypoglobulinemia, an American Staffordshire terrier with hypoglobulinemia, and a Pomeranian with unconfirmed hypothyroidism. Squamous cell carcinoma (SCC) arose within several plaques in the Pomeranian. Clinical improvement coincided in the first two cases with treatment of the concurrent disease and the administration of low-dose oral interferon-alpha. This is the first report of PEP in an American Staffordshire terrier and a Pomeranian. The potential for malignant transformation of PEP to SCC emphasizes the need for recognition and clinical management of PEP.     

Isolation of Escherichia coli O157:H7 from the gall bladder of inoculated and naturally-infected cattle

To determine if Escherichia coli O157:H7 is capable of residing in the gall bladder of cattle, inoculation studies were conducted with O157:H7 strain 86-24 in weaned Holstein calves. Strain 86-24 was isolated from the gall bladders of five calves 36 days after inoculation. Two other calves contained the inoculation strain in the distal colon but the organism was absent in their gall bladders. A second trial in which the calves were euthanized 15 days after inoculation found strain 86-24 in six of seven inoculated calves but only in colon and/or rumen samples. In a third trial that inoculated eight calves with a four-strain cocktail of O157:H7 strains, the gall bladders from all eight animals were positive 9 days after inoculation. The colon and rumen samples from these calves were also positive. E. coli O157:H7 isolates recovered from bile samples and subtyped by pulsed field gel electrophoresis found that three of the four inoculation strains were present in one or more of the calves. Thus, residence in the gall bladder is not restricted to a single strain. Additional evidence of the ability to localize in the gall bladder of cattle was provided by testing the bile from 150 gall bladders (five collection dates, 30 samples each) obtained at an abbatoir and the isolation of E. coli O157:H7 from four samples (2.7%). This study establishes that E. coli O157:H7 can reside transiently or permanently at a low level in the gall bladder of cattle.     

EVALUATION OF CONTRAST‐ENHANCED ULTRASONOGRAPHY AS A METHOD FOR DETECTING GALLBLADDER NECROSIS OR RUPTURE IN DOGS

Gall bladder necrosis and rupture are life‐threatening conditions in dogs requiring surgical intervention and early diagnosis is essential. Human patients with suspected gall bladder necrosis/rupture are commonly evaluated with contrast‐enhanced ultrasonography (CEUS), however this procedure has not been described in dogs with suspected gall bladder necrosis/rupture. In a prospective diagnostic cohort study, CEUS (using SonoVue contrast medium) was performed in 93 dogs with gallbladder lesions identified by abdominal conventional ultrasonography. Necrosis/rupture was identified by CEUS as a focal lack of enhancement of the gallbladder wall. Dogs with positive CEUS finding for necrosis/rupture (complete lack of regional wall enhancement) underwent immediate surgery as did dogs with other biliary disorders requiring surgery. Dogs with negative CEUS findings or those not requiring surgery were managed medically. In cases undergoing surgery, necrosis/rupture was confirmed intraoperatively (and via histopathology). Absence of necrosis/rupture was confirmed either intraoperatively (via histopathology) or was assumed to be absent by complete recovery with medical management. Forty‐nine dogs underwent surgery and cholecystectomy: 24 had necrosis/rupture. CEUS was more accurate (100% sensitive and specific) in diagnosing gallbladder wall necrosis/rupture than conventional ultrasonography (75% sensitive and 81% specific) (P < 0.03). In conclusion, CEUS provides accurate characterization of gallbladder wall integrity that can impact decisions regarding clinical management, either surgical or medical.     

Contrast‐enhanced ultrasound complements two‐dimensional ultrasonography in diagnosing gallbladder diseases in dogs

Gall‐bladder diseases are common in dogs and two‐dimensional ultrasonography is a current standard method for diagnosis and treatment planning. However, findings from this modality can be nonspecific. The aim of this retrospective, case series study was to describe conventional and contrast‐enhanced ultrasound (using SonoVue^®) findings in a group of dogs with histologically confirmed gall bladder disease. A total of 65 dogs were included. Branchlike, heterogeneous, and homogeneous contrast enhancement of echogenic intraluminal mass‐forming lesions was a contrast‐enhanced ultrasound characteristic of polypoid lesions due to cystic mucosal hyperplasia of the gallbladder and/or tumor, which had different wash‐in and washout characteristics. In dogs with mobile or immobile biliary sludge or mucocele, the echogenic intraluminal masses remained unenhanced. A double rim mark or enhancement defect in the gallbladder wall was a characteristic of edema or necrosis/rupture of the wall, respectively. Conventional ultrasonography correctly identified biliary sludge or mucocele in 36/37 dogs, cholecystitis/edema in 44/47 dogs, necrosis/rupture in 19/25 dogs, and gallbladder neoplasia in three of three dogs with these pathologies. It falsely identified biliary sludge or mucocele in eight of 28 dogs, cholecystitis/edema in three of 15 dogs, necrosis/rupture in 13/37 dogs, and gall‐bladder neoplasia in 20/59 dogs that did not have these pathologies. Contrast‐enhanced ultrasound correctly identified cholecystitis/edema in 42/47 dogs, but falsely identified cholecystitis/edema in three of 18 dogs. It correctly identified necrosis/rupture, benign polypoid lesions, and gallbladder neoplasia in all dogs with no false‐positive results. Findings supported contrast‐enhanced ultrasound as a complement to conventional ultrasonography for dogs with suspected gallbladder pathologies such as edema, necrosis, and rupture.     

Intraoperative hypertensive crisis in a dog with functional paraganglioma of the gall bladder

A 15-year-old spayed female mongrel presented with anorexia and an abdominal mass. The mass originated from the gall bladder and was surgically resected along with divisionectomy of the central hepatic division. Paroxysmal hypertension and tachycardia were noted during manipulation of the mass. Following resection, arterial blood pressure decreased significantly. Histopathological analysis confirmed a diagnosis of neuroendocrine neoplasm. Immunohistochemical staining for synaptophysin and chromogranin A yielded diffuse and strong positive results, while gastrin was positive in only 10% of the cells. The preoperative elevated concentrations of catecholamine in the urinalysis showed a marked decrease after surgery. Based on these findings, the tumour was diagnosed as a functional paraganglioma of the gall bladder. The patient has undergone regular thoracic radiographs and ultrasound examinations and, until 431 days after surgery, has shown no signs of metastases or recurrences. Based on our literature search, we report the first case of functional paraganglioma of the gall bladder in a dog.     

Genetic cause for congenital methemoglobinemia in an Australian Pomeranian dog

Little is known about genetic causes of congenital methemoglobinemia in dogs. Here, we report a CYB₅R₃ mutation in a Pomeranian dog with congenital methemoglobinemia. A 6‐year‐old neutered female Pomeranian dog was investigated for cyanosis noticed during anesthesia for an orthopedic procedure. The history included lifelong mild exercise intolerance and bluish tongue. Methemoglobinemia was diagnosed using co‐oximetry. The CYB₅R₃ gene was analyzed by comparing the patient's genomic DNA with the reference canine sequence. Mutation functional significance was investigated using snpEff and multispecies protein homology analyses. A homozygous missense single nucleotide CYB₅R₃ mutation (ATC ? CTC at codon 194) caused a p.Ile194Leu substitution. The pIle194 residue is highly conserved in other mammals, supporting the likely pathogenicity of the substitution. The mutation described here is identical to that associated with familial methemoglobinemia in a family of Japanese Pomeranian dogs. This observation, together with the homozygous mutation found in our case, indicates that the mutant allele may be widespread within the Pomeranian breed internationally.     

Bile peritonitis associated with gastric dilation-volvulus in a dog

This report describes a case of septic peritonitis and gall bladder rupture in German shepherd dog that developed 7 d after surgical treatment for gastric dilation-volvulus. Histological examination confirmed gall bladder necrosis, secondary to an acute ischemic event. Postoperative acute necrotizing cholecystitis has not been a previously reported complication in dogs.     

Concurrent gall bladder,liver lobe torsion,and bile peritonitis in a German shepherd dog 2 months after gastric dilatation/volvulus gastropexy and splenectomy

Postmortem examination of a 7-year-old German shepherd dog which had gastric dilatation/volvulus and splenectomy 2 months earlier revealed that the right middle and quadrate liver lobes were diffusely congested and torsed. The gall bladder was grossly distended and torsed along its long axis and there was evidence of bile peritonitis.