Diagnostic and surgical treatment for traumatic bile peritonitis in dogs and cats

OBJECTIVE

To describe short-term outcomes of dogs and cats undergoing surgery for traumatic bile peritonitis.

ANIMALS

13 dogs and 4 cats.

METHODS

Multi-institutional, retrospective study. Medical records from 6 institutions were reviewed for cases of traumatic bile peritonitis between 2006 and 2022. Clinical presentation, additional injuries, surgical treatment, and outcome were recorded.

RESULTS

Trauma occurred a median of 2 (range, 1 to 22) and 4 (range, 1 to 22) days prior to presentation in dogs and cats, respectively. Total bilirubin was increased in 11 of 13 dogs and 2 of 4 cats. Rupture occurred at the common bile duct (CBD) in 10 dogs and 1 cat, gallbladder in 3 dogs, cystic duct in 2 cats, and hepatic duct in 1 dog and 1 cat. The most common surgeries were cholecystoduodenostomy and CBD repair in dogs and cholecystectomy in cats. Eleven of 13 dogs and all cats survived to hospital discharge (88.2% overall survival). Median follow-up in surviving dogs and cats was 35 days (range, 14 to 401) and 30 days (range, 14 to 90), respectively. One dog that underwent cholecystectomy experienced recurrent bile peritonitis 20 days postoperatively. Short-term survival following surgical treatment of traumatic bile peritonitis was excellent and recurrence appears uncommon. The most frequent site of rupture was the CBD in dogs and the cystic duct in cats.

CLINICAL RELEVANCE

Measurement of peritoneal bilirubin should be considered in dogs and cats with peritoneal effusion following trauma. Surgeons should be prepared to identify and address ruptures in locations other than the gallbladder.

Surgical treatment of hepatobiliary cystadenomas in cats: five cases (1988-1993)

Medical records of 5 cats with hepatobiliary cystadenomas treated by means of surgical excision were reviewed. All cats were examined because of lethargy or abdominal enlargement. A cystic liver mass was seen in each cat ultrasonographically. Postoperative complications did not develop, and none of the cats developed evidence of tumor recurrence. Four cats died 12 to 44 months after surgery. Two cats were euthanatized for unrelated problems, and 2 cats died suddenly 25 and 44 months after surgery; the causes of death were not determined in either case. One cat was alive and considered clinically normal on physical examination 42 months after surgery.

Chylous ascites in cats: nine cases (1978-1993)

Medical records of 9 cats with chylous ascites that underwent exploratory celiotomy were reviewed. In 7 cats, chylous ascites was associated with intra-abdominal neoplasia: 4 cats had an unresectable tumor (hemangiosarcoma, 3 cats; paraganglioma, 1 cat) within the mesenteric root; 2 had malignant lymphoma of the small intestine and mesenteric lymph nodes; and 1 had lymphangiosarcoma of the abdominal wall. In 2 cats, chylous ascites was associated with nonneoplastic diseases: 1 cat had severe biliary cirrhosis and an extrahepatic portosystemic shunt; the other had steatitis caused by vitamin E deficiency. Three cats were euthanatized or died at the time of surgery, and 5 cats were euthanatized within 3 months of surgery. One cat with malignant lymphoma responded well to chemotherapy and lived for 14 months after surgery.

Correction of mandibular nonunion and malocclusion by plate fixation and autogenous cortical bone grafts in two dogs

Two dogs were treated for severe malocclusion secondary to segmental defects in the mandibular bodies as a result of nonhealing mandibular fractures. The problems of fibrous nonunions with large fracture gaps, the potential for infection, and the severe malocclusion were addressed in considering definitive surgical correction. The segmental defects in both dogs were spanned by use of autogenous cortical grafts (full-thickness rib segments or full cortical diaphyseal ulnar segments), supplemented with autogenous cancellous graft, and were stabilized with screw-and-plate fixation. Radiographic evaluation of bone healing and graft incorporation was difficult because of the implants, which obscured full observation of the bone graft sites. Successful graft revascularization, determined by 99mradiophosphate localization, was shown in both dogs; fairly uniform isotope uptake was observed throughout the graft sites and was continuous with the recipient bone. Mildly increased uptake was observed at 6 months and at 1 year after surgery and was considered consistent with remodeling associated with fracture healing. Observation of complete graft revascularization within 1 year provided ample evidence that the autografts were incorporated, with sufficient remodeling to characterize bone union.

Surgical stapling of the small intestine

Intestinal resection and anastomosis, bypass enterostomy, and typhlectomy are indicated for many intestinal disorders. The thoracoabdominal and end-to-end anastomosis stapling instruments all may be used to perform a variety of small intestinal surgical procedures.

Internal skeletal fixation using a Kirschner apparatus for stabilization of fracture/luxations of the lumbosacral joint in six dogs. A modification of the transilial pin technique

A technique using a modification of the transilial pin technique for stabilization of fracture/luxations of the lumbosacral joint was performed in six dogs. This technique used an internal skeletal fixator composed of two transilial pins secured with two double fixator clamps. Collapse (shortening) of the seventh lumbar vertebra (L7) was observed in five dogs without compromise of the vertebral canal. Kirschner wires placed across the articular facets as supplemental fixation devices migrated to the subcutaneous tissues in two dogs and were easily removed. Migration of the internal fixators was not observed during healing; vertebral canal dimensions were maintained in all cases, and the internal fixators were not removed after resolution of fracture healing. All fractures were healed within 6 to 12 weeks of surgery without evidence of pain, neurologic impairment, or long-term complications.

Open Intestinal Anastomosis with Surgical Stapling Equipment in 24 Dogs and Cats

Surgical stapling equipment was used to perform open antiperistaltic side-to-side ("functional end-to-end") entero-anastomoses in 20 dogs and 4 cats. Twenty-one anastomoses healed uneventfully. Seven animals with severe bacterial peritonitis required open peritoneal drainage and delayed abdominal closure. There was postoperative leakage at the anastomotic site in two dogs and a localized abscess at the staple line in one cat. No long-term complications occurred in follow-up periods of 3 to 29 months.