Cholecystojejunostomy in a Cat with common Bile Duct Obstruction

Abstract

Background: Domestic cats are affected by several hepatic diseases, among which biliary tract disorders are the second most common, behind hepatic lipidosis. The causes of those disorders are controversial, but inflammatory diseases are frequently associated with this comorbidity. The diagnosis is realized by laboratory exams and abdominal ultrasonography. A complete obstruction of the biliary tract is a surgical emergency and the desobstruction or deviation of flow must be carried out as soon as possible. Our objective here is to report the clinical pathology findings and the surgical therapy of a biliary duct obstruction in a cat. 

Case: A 6-year-old male mixed-breed cat with history of chronic rhinosinusitis was treated at the Veterinary Medical Teaching Hospital of Rio de Janeiro Federal Rural University (UFRRJ), presenting prostration, anorexia and jaundice for 4 days. We request laboratory tests (hemograma and liver and kidney bichemical profile) and the hepatic enzymes showed increased. Due to the alterations related to cholestasis the patient underwent abdominal ultrasonography evaluation, which revealed cholangiohepatitis, thickened gallbladder with a large amount of bile sludge, severe extrahepatic bile duct dilatation and the presence of a duodenal papillary mass with approximate diameter of 0.5 cm. Therefore, a bile sample was collected for culture and antibiogram, which isolated Enterococcus sp. Furthermore, guided cytology of the mass was performed, which suggested duct hyperplasia and fibrosis. Because the findings indicated serious mechanical obstruction of the extrahepatic bile ducts caused by the duodenal papillary hyperplasia, and due to the negative response to conservative clinical management, the patient was referred for cholecystojejunostomy to divert the bile flow to the small intestine. Also, during the surgery we collected material from the liver, gallbladder, intestine and pancreas for histopathological analysis and culture and antibiogram testing with the objective to diagnosing alterations compatible with the feline triad. There was bacterial development in all the organs collected except the pancreas, supporting the histopathological results, indicating chronic cholecystitis, mild lymphoplasmacytic enteritis, and chronic pericholangitis of the liver, but no alterations in the pancreas. The post-surgical treatment consisted of antibiotic therapy based on the culture and antibiogram results and administration of corticoids. Finally, an esophagostomy tube was placed for correct alimentary management.

Discussion: The total obstruction of biliary tract in cats is a serious disease that demands surgical intervention. The causes are diverse, but it commonly attacks felines with inflammatory disease, as in the present case. During the surgery, we attempted to achieve mechanical clearance through retrograde and normograde pinning with urethral tube with no success. Thus the technique chosen to divert the gallbladder flow to the small intestine was cholecystojejunostomy because it is easier to manipulate and migrate the jejunum to the gallbladder. There were no complications during or after surgery, and the animal did not present recurrence, showing that the technique was efficient at promoting the cat’s welfare even with reserved prognosis. The patient survived for 260 days and according to the necropsy died of hyper accurate cardiac failure not related with the cholecystojejunostomy.

Keywords:  cholecystojejunostomy, biliary flow diversion, domestic cat.