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Biliary Tree Rupture and Bile Peritonitis in Small Animals

By

Sharon A. Center

, BS, DVM, DACVIM, Department of Clinical Sciences, College of Veterinary Medicine, Cornell University

Last full review/revision May 2015 | Content last modified May 2015

Rupture of the common bile duct, cystic duct, hepatic ducts, or gallbladder is most often associated with cholelithiasis, necrotizing choledochitis or cholecystitis, blunt abdominal trauma, or neoplasia. In dogs, necrotizing cholecystitis most often occurs as a result of a mature gallbladder mucocele that stretches the gallbladder wall to the extent of causing ischemic necrosis. Regardless of cause, rupture of any portion of the biliary tree can lead to bile peritonitis. Clinical signs may be minimal early in the disease process, consisting only of inappetence and vague abdominal discomfort. With chronicity, free bile initiates an inflammatory reaction (chemical peritonitis), an abdominal effusion accumulates, and vivid jaundice develops. Ultrasonography should guide collection of abdominal effusion as close to the biliary tree as possible, because this will increase detection of free and phagocytized bilirubin crystals and bacterial organisms. Abdominal adhesions develop with delay in diagnosis and complicate surgical remediation.

Surgical interventions are specific to the causal lesions and may involve biliary tree decompression, cholecystectomy, cholecystotomy, choledochotomy, biliary-enteric anastomosis, or bile duct stent insertion. A liver biopsy should be collected to identify antecedent or coexistent hepatobiliary disease. Portions of the ruptured structure, bile, and abdominal effusion should be sampled and cultured for aerobic and anaerobic bacteria. Affected tissue and adjacent and nonadjacent liver tissue should be biopsied. The abdominal cavity must be thoroughly lavaged with sterile warm saline to remove bile contamination. Antibiotic coverage against likely enteric opportunists (gram-negative bacteria) and anaerobic flora is recommended, eg, ticarcillin, piperacillin, third-generation cephalosporins, or enrofloxacin combined with metronidazole. Antimicrobial therapy should begin before surgery and, if sepsis is confirmed, continued for 4–8 wk. Antimicrobial selection should be guided initially by results of cytology and Gram staining, and adjusted based on results of culture and sensitivity. Animals with chronic jaundice should receive vitamin K1 (0.5–1.5 mg/kg, IM or SC, bid for up to three doses) before surgical intervention. Fresh frozen plasma may be necessary to abate bleeding tendencies during emergency surgery. Antiemetics are recommended if the animal is vomiting; H2-receptor antagonists are used if enteric bleeding is identified, because these act quickly. In animals with cholelithiasis and in dogs with gallbladder mucocele, hydrocholeresis (ursodeoxycholic acid and SAMe) and antioxidants (vitamin E and SAMe) are recommended postoperatively.

OTHER TOPICS IN THIS CHAPTER
Hepatic Disease in Small Animals
Overview of Hepatic Disease in Small Animals
Hematology in Hepatic Disease in Small Animals
Coagulation Tests in Hepatic Disease in Small Animals
Enzyme Activity in Hepatic Disease in Small Animals
Other Serum Biochemical Measures in Hepatic Disease in Small Animals
Hepatic Function Tests in Small Animals
Imaging in Hepatic Disease in Small Animals
Cholecystocentesis in Hepatic Disease in Small Animals
Liver Cytology in Small Animals
Liver Biopsy in Small Animals
Pathologic Changes in Bile in Small Animals
Nutrition in Hepatic Disease in Small Animals
Fulminant Hepatic Failure in Small Animals
Hepatic Encephalopathy in Small Animals
Portal Hypertension and Ascites in Small Animals
Portosystemic Vascular Malformations in Small Animals
Acquired Portosystemic Shunts in Small Animals
Other Hepatic Vascular Disorders in Small Animals
Hepatotoxins in Small Animals
Infectious Diseases of the Liver in Small Animals
Feline Hepatic Lipidosis
Biliary Cirrhosis in Small Animals
Canine Cholangiohepatitis
Canine Chronic Hepatitis
Lobular Dissecting Hepatitis in Small Animals
Canine Vacuolar Hepatopathy
Metabolic Diseases Affecting the Liver in Small Animals
Hepatocutaneous Syndrome in Small Animals
Nodular Hyperplasia in Small Animals
Hepatic Neoplasia in Small Animals
Miscellaneous Liver Diseases in Small Animals
Diseases of the Gallbladder and Extrahepatic Biliary System in Small Animals
Cholecystitis in Small Animals
Canine Gallbladder Mucocele
Other Disorders of the Gallbladder in Small Animals
Other Disorders of the Bile Ducts in Small Animals
Extrahepatic Bile Duct Obstruction in Small Animals
Cholelithiasis in Small Animals
Biliary Tree Rupture and Bile Peritonitis in Small Animals
Feline Cholangitis/Cholangiohepatitis Syndrome
Hepatobiliary Fluke Infection in Small Animals
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