Extruded gallbladder mucoceles have characteristic ultrasonographic features and extensive migratory capacity in dogs

Preoperative serum C-reactive protein concentration can be used to detect gallbladder rupture in dogs with gallbladder mucocele

OBJECTIVE

To determine whether serum C-reactive protein (CRP) concentration could be used to detect gallbladder rupture (GBR) prior to surgery in dogs undergoing cholecystectomy for treatment of gallbladder mucocele (GBM).

ANIMALS

45 dogs that underwent cholecystectomy because of GBM at a companion animal referral hospital from 2017 to 2020.

PROCEDURES

Electronic medical records were reviewed, and dogs were included if serum CRP concentration had been measured within 24 hours prior to cholecystectomy. Dogs were grouped as to whether the gallbladder was found to be ruptured or intact during surgery. Accuracy of using preoperative CRP concentration to predict GBR was compared with accuracy of abdominal ultrasonography and other preoperative blood tests.

RESULTS

GBR was present in 15 dogs at the time of surgery. Median preoperative CRP concentration was significantly higher in dogs with GBR (15.1 mg/dL; interquartile range, 7.4 to 16.8 mg/dL) than in dogs with an intact gallbladder (2.65 mg/dL; interquartile range, 0.97 to 13.4 mg/dL). Sensitivity, specificity, and accuracy of using preoperative CRP concentration to predict GBR were 100%, 67%, and 78%, respectively.

CLINICAL RELEVANCE

Measurement of preoperative CRP concentration provided excellent sensitivity and moderate specificity for detection of GBR in dogs undergoing cholecystectomy because of GBM. Accuracy of using preoperative CRP concentration for detection of GBR was not superior to the accuracy of preoperative abdominal ultrasonography. However, when CRP concentration was combined with results of ultrasonography, the sensitivity, specificity, and accuracy for detection of GBR were 100%, 93%, and 96%, respectively.

Canine extrahepatic biliary disease: what have we learned?

Extrahepatic biliary disease in dogs is commonly encountered in clinical practice worldwide. Diseases in this segment of the biliary tract are diverse and can manifest with mild clinical signs or can be life-threatening. In the last decade there have been advances in diagnostic tests, imaging modalities and therapeutic interventions as well as the identification of novel prognostic variables that could improve outcomes in dogs with extrahepatic biliary disease. Therefore, the objective of this review was to summarise clinically relevant updates of extrahepatic biliary disease in dogs.

Influence of normograde versus retrograde catheterization of bile ducts in dogs treated for gallbladder mucocele

OBJECTIVE

To determine the influence of normograde (NG) versus retrograde (RG) catheterization of the cystic duct and common bile duct (CBD) in dogs with gallbladder mucoceles (GBM) treated with open cholecystectomy.

STUDY DESIGN

Retrospective study.

ANIMALS

Dogs (n = 117) with GBM.

METHODS

Medical records were reviewed for signalment, history, clinical laboratory and diagnostic imaging findings, details of surgery including catheterization method, complications, and outcome. Long-term follow-up data were obtained by telephone or electronic communication. Relationships between catheterization method and clinical variables and outcome were evaluated.

RESULTS

Dogs catheterized RG were more likely to experience any postoperative complication (p = .0004) including persistence of gastrointestinal signs (p = .0003). Survival to discharge and long-term survival did not differ by group (p = .23 and p = .49). Total bilirubin (TB) decreased by 70.3% after NG catheterization compared to 39.1% after RG catheterization (p = .03) and increased in 14.9% dogs catheterized NG and 38.0% dogs catheterized RG (p = .004). The presence of a diplomate surgeon at surgery resulted in decreased incidences of any perioperative or postoperative complication (p = .003 and p = .05).

CONCLUSION

Retrograde catheterization was associated with more postoperative concerns than NG catheterization, but similar survival times. Surgery should be performed by diplomates experienced in biliary surgery to minimize complications.

CLINICAL SIGNIFICANCE

Although both NG and RG techniques to catheterize the cystic duct and CBD are options for treatment of GBM with low mortality, results of this study provide some evidence to recommend NG over RG catheterization.

The Site of Origin of Canine Abdominal Masses Correlates with the Risk of Malignancy: Retrospective Study of 123 Cases

Simple Summary

The detection of abdominal masses in dogs is a common finding in clinical practice. While data regarding masses in specific abdominal organs are available in the literature, studies comparing the site distribution of benign versus malignant lesions are scarce. The aim of this study was to retrospectively describe the tissue distribution and diagnosis of surgically excised abdominal masses in a canine population. A total of 123 abdominal masses were classified based on the organ of origin and histologically classified as non-neoplastic (39), benign neoplasia (15), and malignant neoplasia (69). Gastrointestinal masses were more likely to be malignant than masses in other sites. The masses not associated with any organ were significantly larger than the genital and splenic lesions, and no association between size and malignancy was found. This case series suggests that, while the size of the lesion cannot be used as a parameter to predict the probability of a mass being malignant neoplasm, the gastrointestinal site may be used for this scope, providing useful information for primary care clinicians.

Abstract

The detection of an abdominal mass represents a common finding in clinical practice. The aim of this study was to retrospectively describe the tissue distribution and diagnosis of abdominal masses amenable to surgical removal in a canine population. Dogs with abdominal masses with a minimum diameter of 3 cm were selected. Cases were classified, based on the anatomical location, as splenic, gastrointestinal, hepatobiliary, genital, and masses not associated with any organ. Masses were surgically removed and formalin-fixed for the histological examination. Collected data were statistically analyzed. A total of 123 masses were collected from 122 dogs. Sixty-nine masses were classified as malignant neoplasia, 15 as benign, and 39 as non-neoplastic. The abdominal masses were 5.8-fold more likely to be malignant if located in the gastrointestinal tract (p = 0.01). A significant association between the size and the site of the masses was identified, the masses not associated with any organ being larger than the genital and splenic lesions (p = 0.008). This case series describes the most frequent location in association with the histopathological diagnosis of canine abdominal masses and suggests that the gastrointestinal location was related to a higher risk of representing a malignant neoplasm.

Clinical findings for dogs undergoing elective and nonelective cholecystectomies for gall bladder mucoceles

OBJECTIVES

The purpose of this study was to describe elective and nonelective post-cholecystectomy complications and mortality rates in dogs with a gall bladder mucocele. The secondary purpose was to report complications and mortality rates for different methods of common bile duct catheterisation.

MATERIALS AND METHODS

A multi-institutional retrospective case series was performed to identify dogs with a gall bladder mucocele between 2004 and 2018 that underwent a cholecystectomy. Dogs were classified into nonelective or elective based on the presence or absence, respectively, of gall bladder rupture, biliary duct distension, clinical signs or hyperbilirubinemia. Each cholecystectomy was classified into three groups: duodenotomy and retrograde catheterisation, normograde catheterisation or no catheterisation. Complications were divided into four grades based on increasing severity and mortality rates were assessed for each.

RESULTS

The mortality rate was 2 (6%) out of 31 for dogs undergoing an elective cholecystectomy and 21 (23%) out of 90 for dogs undergoing a nonelective cholecystectomy. The complication rate was 52% for the elective cholecystectomy and 50% for nonelective cholecystectomy. The majority of the complications in the elective category were grade 1 (mild). Post-operative hyperthermia developed in 35% of dogs that had a duodenotomy and retrograde common bile duct catheterisation, in 4% of dogs with a normograde common bile duct catheterisation and in 7% of dogs that did not have the common bile duct catheterised.

CLINICAL SIGNIFICANCE

Elective cholecystectomy in dogs with a gall bladder mucocele in this study carried a low mortality rate and a relatively high frequency of minor complications.

Dogs with biliary rupture based on ultrasound findings may have normal total serum bilirubin values

The absence of hyperbilirubinemia can lead to decreased suspicion of biliary rupture in dogs. This delay of suspicion and treatment can result in increased mortality rates. The objective of this retrospective, observational study was to describe ultrasound and serum bilirubin findings in a group of dogs with an ultrasonographic diagnosis of suspected biliary rupture. The records of a single institution were searched over the period of 2007-2019 for cases having ultrasound reports describing suspicion of biliary rupture. Clinical findings for each of the cases were recorded. A total of 35 dogs met inclusion criteria and, of these, 30 dogs had confirmed ruptured biliary tracts. It was found that 40% (12/30) of dogs with confirmed ruptured biliary tracts had a serum bilirubin values within the normal reference range. No statistical difference was found in serum bilirubin values between the ruptured and nonruptured biliary tracts. Leukocytosis and neutrophilia were found to be statistically significant between ruptured and nonruptured biliary tracts. Mucinous material, similar to "white bile" found in human literature, was found within the peritoneal effusion of six dogs with biliary rupture, three of which also lacked bile pigment. Findings from this study indicated that normobilirubinemia may be present in some dogs with biliary rupture, and therefore should not be used as a reason for excluding this differential diagnosis.

CT attenuation values and mineral distribution can be used to differentiate dogs with and without gallbladder mucoceles

Gallbladder mucoceles are potentially fatal in dogs. Multiphase CT angiography was performed to evaluate the canine gallbladder in three conditions: no sludge, sludge occupying ≥25% of the lumen, and mucoceles. Twenty dogs with normal hepatobiliary bloodwork and no-to-minimal gallbladder sludge, 13 dogs with normal bloodwork and ≥25% sludge in the gallbladder lumen, and 18 dogs with histologically confirmed gallbladder mucoceles were enrolled in a prospective, observational diagnostic accuracy study. Three regions of interest (ROI) were stratified in the dorsal-ventral orientation and a single ROI was measured within the hepatic parenchyma. Mean attenuation and presence of mineral were recorded. Average Hounsfield units (HU) were recorded for precontrast, arterial, portovenous, and late venous phases. The overall median HU value for mucoceles was significantly higher than gallbladders without sludge and with sludge; precontrast median overall attenuation was 49.3, 35.8, and 39.7 HU, respectively (P < .000004). Mineral was seen in four (20%) dogs with no sludge, seven (56%) dogs with sludge, and nine (50%) dogs with mucoceles. Mineral in the dogs with mucoceles was located within the central aspect of the gallbladder lumen in 67% of mucoceles; this mineral distribution was not seen in any dog without a mucocele. Computed tomography can differentiate a subset of gallbladder mucoceles from dogs with and without gallbladder sludge, especially in the precontrast series. An HU value of 48.6 is 52% sensitive and 96% specific for a gallbladder mucocele. A hyperattenuating gallbladder on precontrast CT images and centrally distributed mineral can be a gallbladder mucocele.