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

Abstract

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.

Choledochotomy for Obstructive Choledocholithiasis in Two Dogs

“…Some reported complications following choledochotomy include postoperative bile leakage, dehiscence, stricture, and adhesion formation [16, 18]. Risks factors for complications following choledochotomy have not been proven but are theorized to include increased tension on the repair, tissue friability and the presence of infection [14].…”

“…Choledochotomy alone has historically been shown to be associated with high mortality (100%) and poor long-term prognosis (< 6 months) [6]. One study has shown that choledochotomy performed with cholecystectomy was associated with low perioperative morbidity and no mortality in a small cohort of cases [18].…”

Effect of dilution of canine blood samples on the specificity of saline agglutination tests for immune‐mediated hemolysis

“…32 Similarly, hemolysis can arise through nonimmune-mediated mechanisms, 21,33,34 and some signs consistent with hemolysis can be artifacts (eg, hemolyzed plasma due to traumatic venipuncture or lysis of erythrocytes in urine leading to confusion between intravascular hemolysis and hemorrhage into the urinary tract) 35 or the result of nonhemolytic disease (eg, hyperbilirubinemia due to hepatic 36 or posthepatic disease). 37 9,12,31,[41][42][43] In some cases, this likely reflects variable case and control selection between studies, but variations in test protocols and reagents are also likely a contributing factor. 1, 31 Variation in reported test performance creates difficulty when comparing between studies that use DAT as an inclusion criteria for IMH.…”

Bile peritonitis secondary to projectile trauma from an air gun pellet

“…Primary repair of the bile duct can be attempted if the underlying cause is traumatic rupture and there is little inflammation (Parchman and Flanders 1990, Mehler 2011, Boothe 2015). Bile diversion techniques need to be used to support repair and involves the placement of a bile duct stent from the papilla in the duodenum up the bile duct into the gall bladder to divert bile away from the repair (Mayhew and others 2006, Mayhew and Weisse 2008, Baker and others 2011). In cases where it is not possible to perform a primary repair of the bile duct, a cholecystoduodenostomy is performed to divert the bile into the intestine away from the damaged bile duct (Watkins and others 1983, Mehler and others 2004).…”