Therapeutic percutaneous ultrasound-guided cholecystocentesis in three dogs with extrahepatic biliary obstruction and pancreatitis

Abstract

Three dogs were examined because of acute pancreatitis. In all 3, distension of the gallbladder was seen ultrasonographically, and extrahepatic biliary tract obstruction (EHBO) was diagnosed on the basis of ultrasonographic findings and serum biochemical abnormalities (i.e., high serum bilirubin and cholesterol concentrations and increased hepatic enzyme activities). In all 3 dogs, percutaneous ultrasound-guided cholecystocentesis (PUCC) was used to decompress the gallbladder, with cholecystocentesis performed multiple times in 1 dog. Serum bilirubin concentration was substantially decreased following the procedure in all 3 dogs. Two of the 3 dogs did not require surgery to resolve the obstruction. In the third dog, an exploratory laparotomy was performed because of concerns about development of abdominal effusion following the procedure. Bile staining of the mesenteric fat was seen during the laparotomy, but no defect in the gallbladder wall could be identified. In most dogs with EHBO secondary to pancreatitis, the obstruction resolves spontaneously as the acute pancreatitis improves so that surgery is not required. In those few dogs in which EHBO does not resolve or in which EHBO results in complications, therapeutic PUCC may be useful in relieving gallbladder distension.

Initial experience with endoscopic retrograde cholangiography and endoscopic retrograde biliary stenting for treatment of extrahepatic bile duct obstruction in dogs

“…[14][15][16][17][18][19] In human patients, similar risks and complications of traditional open surgeries in debilitated patients have led to the use of interventional radiology-guided procedures (eg, placement of cholecystostomy tubes and percutaneous biliary stenting) and interventional endoscopy techniques (eg, ERCP and biliary stenting) in an effort to minimize procedure-related complications. 22 The use of cholecystostomy tubes 23 or decompressive cholecystocentesis 24 are other minimally invasive options for temporary biliary decompression, although these procedures do not allow drainage of bile salts into the gastrointestinal tract. 22 The use of cholecystostomy tubes 23 or decompressive cholecystocentesis 24 are other minimally invasive options for temporary biliary decompression, although these procedures do not allow drainage of bile salts into the gastrointestinal tract.…”

“…22 The use of cholecystostomy tubes 23 or decompressive cholecystocentesis 24 are other minimally invasive options for temporary biliary decompression, although these procedures do not allow drainage of bile salts into the gastrointestinal tract. [23][24][25] In 1974, Falkenstein et al 27 reported performing ERCP in healthy dogs for physician training and research purposes and indicated that success in achieving CBD cannulation improved with experience. 25,26 This typically requires enteric bile salt replacement of the drained bile via a feeding tube until patency is reestablished.…”

Liver and biliary tract

“…10,98 Two large retrospective case series have been published reporting on prognostic factors and outcome in biliary diversion surgeries in cats. 36,37 In one, the mortality rate within 48 hours of surgery was 57%; in cats diagnosed with neoplasia it was 100% versus those with non-neoplastic causes, where it was 40%.…”

Pancreatitis

“…The gallbladder can be drained intermittently using needle aspiration under ultrasound guidance (Herman et al 2005). This technique has been described in three clinical dogs without inducing a bile peritonitis.…”