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J Vet Clin 2023; 40(6): 452-456

https://doi.org/10.17555/jvc.2023.40.6.452

Published online December 31, 2023

Contained Gallbladder Rupture in Two Dogs with Small-Sized Gallbladder

Chang-Hwan Moon1 , Hee-Jin Kim1 , Won-Jong Lee1 , Young-Sam Kwon2 , Jae-Min Jeong1 , Dae-Hyun Kim1 , Hae-Beom Lee1 , Seong Mok Jeong1,*

1Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Korea
2Department of Veterinary Surgery, College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Korea

Correspondence to:*jsmok@cnu.ac.kr

Received: November 7, 2023; Revised: November 21, 2023; Accepted: November 22, 2023

Copyright © The Korean Society of Veterinary Clinics.

This report presents two rare cases of gallbladder rupture in dogs with small gallbladders that did not result in bile leakage and their subsequent surgical treatment. The report includes a 5-year-old spayed female Chihuahua weighing 3.5 kg and a 9-year-old castrated male Poodle weighing 5.3 kg. Both dogs had elevated liver enzyme levels on blood chemistry. However, only the second dog (2) (Poodle) presented with hyperbilirubinemia and jaundice, whereas the first dog (Chihuahua (1)) did not display any specific clinical signs. Diagnostic imaging revealed a small gallbladder in both dogs, and the dogs were diagnosed with cholecystolithiasis (1) and extrahepatic biliary tract obstruction (2). No bile leakage-related abdominal effusion was observed. Gallbladder rupture and adhesion to the adjacent tissues were confirmed during cholecystectomy.

Keywords: contained gallbladder rupture, small-sized gallbladder, elevated liver enzymes, cholecystectomy, dog

Gallbladder (GB) rupture is a surgical emergency, due to potential bile leakage and the subsequent development of bile peritonitis (6,8). Although GB rupture can also occur due to abdominal trauma or intraoperative iatrogenic damage, in veterinary medicine, the primary etiology is the progression of GB diseases, such as GB mucocele, cholecystolithiasis, or cholecystitis (3,7,12,13,15). Bile peritonitis can cause inflammatory responses, hemolysis, tissue necrosis, and induce endotoxemia, leading to an increased risk of morbidity and mortality (10). Therefore, in cases in which gallbladder rupture is suspected, rapid diagnosis and prompt surgical intervention are essential. This case report describes the incidental finding of GB rupture in two dogs with elevated liver enzyme levels and small GBs without bile leakage, as typically observed with GB rupture.

Case 1

A 5-year-old spayed female Chihuahua weighing 3.5 kg was referred to the Veterinary Medical Teaching Hospital of Chungnam National University because of elevated liver enzymes detected during pre-anesthetic blood analysis before dental scaling at a local veterinary clinic. The patient had no specific clinical signs upon admission but had a history of vomiting one month prior to admission. Increased canine C-reactive protein (2.8 mg/L; reference range [RR] = 0.1-1 mg/L) and elevated liver enzymes including alanine aminotransferase (ALT) (677 U/L; RR = 10-125 U/L), alkaline phosphate (ALKP) (1,130 U/L; RR = 23-212 U/L), and gamma-glutamyl transferase (GGT) (32 U/L; RR = 0-11 U/L) were observed on serum biochemistry (Catalyst One Chemistry Analyzer; IDEXX Laboratories Inc.; Westbrook, USA). The serum total bilirubin level was within the normal range.

Abdominal radiography revealed a linear radiopaque structure measuring 4.1 mm in length within the right upper abdomen, which was consistent with the presence of cholecystoliths based on its anatomical location. The gallbladder (GB) was rounded and slightly small (10 × 12 mm) on abdominal ultrasonography (Fig. 1A). Echogenic sludge and multiple hyperechoic cholecystoliths were observed in the GB. Furthermore, the GB wall and adjacent structure, presumed to be the greater omentum, was hyperechoic. Computed tomography revealed a small GB measuring 10.8 × 5.2 × 9.2 mm (length × width × height), with multiple cholecystoliths measuring <2 mm inside (Fig. 2A). Additionally, the cystic duct was dilated to 5 mm, and the common bile duct (CBD) opening into the duodenum measured 4.5 mm in diameter, with no choledoliths observed (Fig. 2B). Based on these findings, the patient was diagnosed with cholecystolithiasis. Considering the potential risk of GB rupture or extrahepatic biliary tract obstruction (EHBO), cholecystectomy was planned.

Figure 1.Small-sized gallbladder on preoperative abdominal ultrasonography in case 1 (A) and case 2 (B).

Figure 2.Preoperative computed tomography in case 1: (A) small sized gallbladder (yellow arrow) with cholecystoliths. (B) Dilated distal common bile duct (white arrow) without choledoliths. Du, duodeneum; S, stomach; L, liver.

The dog was preoxygenated with 100% oxygen using a flow-by technique. Cefazolin sodium (22 mg/kg, IV; Cefazolin; Jonggeundang), maropitant (1 mg/kg, SC; Cerenia; Zoetis), and midazolam (0.2 mg/kg, IV; Midazolam Inj.; Bukwang) were administered as pre-medication. Induction was performed by slow administration of propofol (4 mg/kg IV; Anepol; Hana), followed by endotracheal intubation. Anesthesia was maintained using isoflurane (Ifran; Hana), and constant rate infusion of remifentanil (0.1-0.3 ug/kg/min; Remiva Inj.; Hana) was used for perioperative analgesia. When adequate depth of anesthesia was achieved, the patient was placed in dorsal recumbency for surgery. After midline celiotomy, severe adhesions were observed between the GB and adjacent tissues, including the liver, greater omentum, and diaphragm (Fig. 3A). The GB and adherent tissues were carefully dissected, and a small shrunken GB was observed. After confirming the patency of the CBD, cholecystectomy was performed, followed by sufficient abdominal lavage. A Jackson-Pratt drain was placed and the abdominal wall was routinely closed using the three-layer technique.

Figure 3.Intraoperative images (A, B) and resected gallbladder (GB) (C, D) in two dogs. (A) Ruptured GB adhered to surrounding tissues in case 1. (B) Severely dilated common bile duct (white arrow) in case 2 after cholecystectomy (white asterisk). (C) Perforated GB (yellow arrow) in case 1. (D) Perforated GB (yellow arrow) in case 2. D, diaphragm; Q, quadrate hepatic lobe; GB, gallbladder; P, pancerease; Du, duonedum.

Case 2

A 9-year-old castrated male Poodle weighing 5.3 kg presented with a primary complaint of jaundice and anorexia. The patient was lethargic upon presentation and had a history of vomiting > 10 times in the previous 3 days. Serum biochemical results revealed elevated AST (874 U/L; RR = 0-50 U/L), ALT (over, RR = 10-125 U/L), ALKP (3,500 U/L; RR = 23-212 U/L), and GGT (197 U/L; RR = 0-11 U/L). Serum total bilirubin was also increased (30 mg/dL; RR = 0.0-0.9 mg/dL).

No specific findings were observed on abdominal radiography. Abdominal ultrasonography revealed a small GB measuring 10 × 10 mm, with an irregular GB wall containing echogenic sludge (Fig. 1B). The entire extrahepatic biliary tract, including the CBD, showed dilatation of up to 8.3 mm. No choledocholiths obstructing the biliary tree were observed on ultrasonography. The patient was tentatively diagnosed with EHBO. Emergency cholecystectomy was performed to ensure biliary patency.

General anesthesia was administered using the same protocol as described in Case 1. Following midline celiotomy and an additional paracostal incision, a small GB and severe dilatation of the CBD were confirmed (Fig. 3B). The extensive adhesion between the GB and the quadrate hepatic lobe necessitated partial lobectomy to remove the GB. Additionally, retrograde choledochal catheterization and lavage were performed through an antimesenteric incision in the duodenum to ensure biliary patency. Abdominal lavage was also performed, followed by routine closure of the abdominal wall.

In both cases, a small perforation was observed in the resected GB (Fig. 3C, D). Cholecystoliths were identified within the resected GBs in both dogs. The elevated preoperative liver enzyme levels gradually improved postoperatively in both cases (Table 1). There were no specific complications related to cholecystectomy during the postoperative period, and the dogs were discharged without any complications on postoperative days two (Case 1) and five (Case 2).

Table 1 Preoperative and postoperative serum biochemistry results in case 1 and case 2

ParameterReference rangeCase 1Case 2
PreoperativePOD-1POD-4POD-8PreoperativePOD-2POD-8POD-12
AST0-50 (U/L)4411631238742715633
ALT10-125 (U/L)677300153179Over6359343
ALKP23-212 (U/L)1,1303152521793,5003,5002,595786
GGT0-11 (U/L)3250019759303
Total bilirubin0.0-0.9 (mg/dL)0.40.20.30.330.04.12.01.2

POD, postoperative day; AST, aspartate aminotransferase; ALT, alanine aminotransferase; ALP, alkaline phosphatase; GGT, gamma-glutamyl transferase.


Gall bladder rupture in dogs can occur due to various causes, although it is more commonly associated with GB disease than with trauma (4,9,14,17). Bile is sterile in normal dogs; therefore, theoretically, the acute phase of bile peritonitis caused by GB rupture is a non-septic condition (10,16). However, depending on the cause of GB rupture, septic bile peritonitis, which has a guarded prognosis compared with sterile bile peritonitis, can develop or progress (9,10,12). Patients suspected of having bile leakage or bile peritonitis are at risk of deterioration at any time. Therefore, prompt surgical intervention is recommended to help improve the prognosis.

The presentation of clinical signs in dogs with gallbladder rupture can range from asymptomatic to severe shock, and is likely associated with factors such as the volume of bile leakage and the presence of bacterial infection (8,9,11). Clinical manifestations are typically nonspecific and include lethargy, anorexia, vomiting, diarrhea, abdominal pain, distention, and jaundice (8,11). Notably, GB rupture should be suspected when abdominal radiography reveals decreased serosal detail, and discontinuity of the GB wall, hyperechoic structures adjacent to the GB, or free fluid accumulation in the abdominal cavity on abdominal ultrasonography (1,5,8). Diagnostic imaging is not infallible, as it lacks both sensitivity and specificity for the definitive diagnosis of GB rupture (1,6). Typically, analyzing the bilirubin concentration of the abdominal fluid obtained through abdominocentesis and comparing it to serum bilirubin levels is an effective method for diagnosing bile leakage resulting from GB rupture (2,8,9).

During the surgery, there was no evidence of bile leakage associated with GB rupture in both our cases. Small-sized GB were observed on abdominal ultrasonography in both dogs. Rupture of the GB is suspected to have resulted from cholecystitis induced by cholecystolithiasis. It is presumed that only a small amount of bile leakage occurred at the time of GB rupture, and that the perforated GB adhered to the surrounding tissues, such as the hepatic lobe, greater omentum, or diaphragm, during the acute phase, preventing continuous leakage and the development of bile peritonitis. In Case 1, there were no specific biochemical findings except for elevated liver enzyme levels. In Case 2, although the dog exhibited vomiting and jaundice, this was believed to be unrelated to the GB rupture and was attributed to EBHO.

Even in cases where there is no evidence or clinical signs related to bile leakage or bile peritonitis, the presence of elevated liver enzymes in biochemistry and a small-sized gallbladder observed on abdominal ultrasonography should raise the suspicion of gallbladder rupture.

Conceptualization: Moon CH, Jeong SM; Data curation: Moon CH, Kim HJ, Lee WJ; Formal analysis: Moon CH, Kim HJ; Funding acquisition: Jeong SM; Investigation: Moon CH; Supervision: Jeong SM; Writing - original draft: Moon CH; Writing - review & editing: Moon CH, Kwon YS, Jeong JM, Kim DH, Lee HB, Jeong SM.

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. 2022R1F1A1071251).

  1. Bargellini P, Orlandi R, Paloni C, Rubini G, Fonti P, Peterson ME, et al. Evaluation of contrast-enhanced ultrasonography as a method for detecting gallbladder necrosis or rupture in dogs. Vet Radiol Ultrasound. 2016; 57: 611-620.
    Pubmed CrossRef
  2. Bohn AA. Analysis of canine peritoneal fluid analysis. Vet Clin North Am Small Anim Pract. 2017; 47: 123-133.
    Pubmed CrossRef
  3. Brömel C, Léveillé R, Scrivani PV, Smeak DD, Podell M, Wagner SO. Gallbladder perforation associated with cholelithiasis and cholecystitis in a dog. J Small Anim Pract. 1998; 39: 541-544.
    Pubmed CrossRef
  4. Church EM, Matthiesen DT. Surgical treatment of 23 dogs with necrotizing cholecystitis. J Am Anim Hosp Assoc. 1988; 24: 305-310.
  5. Crews LJ, Feeney DA, Jessen CR, Rose ND, Matise I. Clinical, ultrasonographic, and laboratory findings associated with gallbladder disease and rupture in dogs: 45 cases (1997-2007). J Am Vet Med Assoc. 2009; 234: 359-366.
    Pubmed CrossRef
  6. Guess SC, Harkin KR, Biller DS. Anicteric gallbladder rupture in dogs: 5 cases (2007-2013). J Am Vet Med Assoc. 2015; 247: 1412-1414.
    Pubmed CrossRef
  7. Jaffey JA, Graham A, VanEerde E, Hostnik E, Alvarez W, Arango J, et al. Gallbladder mucocele: variables associated with outcome and the utility of ultrasonography to identify gallbladder rupture in 219 dogs (2007-2016). J Vet Intern Med. 2018; 32: 195-200; Erratum in: J Vet Intern Med 2018; 32: 1290.
    Pubmed KoreaMed CrossRef
  8. Ludwig L, Smarick S. Biliary emergencies. In: Aronson LR, editor. Small animal surgical emergencies. Hoboken: John Wiley & Sons. 2015: 89-104.
    CrossRef
  9. Ludwig LL, McLoughlin MA, Graves TK, Crisp MS. Surgical treatment of bile peritonitis in 24 dogs and 2 cats: a retrospective study (1987-1994). Vet Surg. 1997; 26: 90-98.
    Pubmed CrossRef
  10. Mayhew PD, Weisse C. Liver and biliary system. In: Johnston SA, Tobias KM, editors. Veterinary surgery: small animal expert consult. St. Louis: Elsevier. 2018: 1828-1852.
  11. Mehler SJ, Mayhew PD. Extrahepatic biliary tract obstruction. In: Monnet E, editor. Small animal soft tissue surgery. Hoboken: John Wiley & Sons. 2012: 462-484.
    CrossRef
  12. Mehler SJ, Mayhew PD, Drobatz KJ, Holt DE. Variables associated with outcome in dogs undergoing extrahepatic biliary surgery: 60 cases (1988-2002). Vet Surg. 2004; 33: 644-649.
    Pubmed CrossRef
  13. Parchman MB, Flanders JA. Extrahepatic biliary tract rupture: evaluation of the relationship between the site of rupture and the cause of rupture in 15 dogs. Cornell Vet. 1990; 80: 267-272.
  14. Pike FS, Berg J, King NW, Penninck DG, Webster CR. Gallbladder mucocele in dogs: 30 cases (2000-2002). J Am Vet Med Assoc. 2004; 224: 1615-1622.
    Pubmed CrossRef
  15. Pikoulis E, Daskalakis P, Avgerinos ED, Gougoudi E, Karavokyros I, Leppäniemi A, et al. Blunt trauma to the extrahepatic biliary tract. A multicenter study. Ann Ital Chir. 2006; 77: 319-322.
  16. Wilbur BG, Gomez FC, Tompkins RK. Canine gallbladder bile. Effects of proximal gastric vagotomy, truncal vagotomy, and truncal vagotomy with pyloroplasty on volume and composition. Arch Surg. 1975; 110: 792-796.
    Pubmed CrossRef
  17. Worley DR, Hottinger HA, Lawrence HJ. Surgical management of gallbladder mucoceles in dogs: 22 cases (1999-2003). J Am Vet Med Assoc. 2004; 225: 1418-1422.
    Pubmed CrossRef

Article

Case Report

J Vet Clin 2023; 40(6): 452-456

Published online December 31, 2023 https://doi.org/10.17555/jvc.2023.40.6.452

Copyright © The Korean Society of Veterinary Clinics.

Contained Gallbladder Rupture in Two Dogs with Small-Sized Gallbladder

Chang-Hwan Moon1 , Hee-Jin Kim1 , Won-Jong Lee1 , Young-Sam Kwon2 , Jae-Min Jeong1 , Dae-Hyun Kim1 , Hae-Beom Lee1 , Seong Mok Jeong1,*

1Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Korea
2Department of Veterinary Surgery, College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Korea

Correspondence to:*jsmok@cnu.ac.kr

Received: November 7, 2023; Revised: November 21, 2023; Accepted: November 22, 2023

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This report presents two rare cases of gallbladder rupture in dogs with small gallbladders that did not result in bile leakage and their subsequent surgical treatment. The report includes a 5-year-old spayed female Chihuahua weighing 3.5 kg and a 9-year-old castrated male Poodle weighing 5.3 kg. Both dogs had elevated liver enzyme levels on blood chemistry. However, only the second dog (2) (Poodle) presented with hyperbilirubinemia and jaundice, whereas the first dog (Chihuahua (1)) did not display any specific clinical signs. Diagnostic imaging revealed a small gallbladder in both dogs, and the dogs were diagnosed with cholecystolithiasis (1) and extrahepatic biliary tract obstruction (2). No bile leakage-related abdominal effusion was observed. Gallbladder rupture and adhesion to the adjacent tissues were confirmed during cholecystectomy.

Keywords: contained gallbladder rupture, small-sized gallbladder, elevated liver enzymes, cholecystectomy, dog

Introduction

Gallbladder (GB) rupture is a surgical emergency, due to potential bile leakage and the subsequent development of bile peritonitis (6,8). Although GB rupture can also occur due to abdominal trauma or intraoperative iatrogenic damage, in veterinary medicine, the primary etiology is the progression of GB diseases, such as GB mucocele, cholecystolithiasis, or cholecystitis (3,7,12,13,15). Bile peritonitis can cause inflammatory responses, hemolysis, tissue necrosis, and induce endotoxemia, leading to an increased risk of morbidity and mortality (10). Therefore, in cases in which gallbladder rupture is suspected, rapid diagnosis and prompt surgical intervention are essential. This case report describes the incidental finding of GB rupture in two dogs with elevated liver enzyme levels and small GBs without bile leakage, as typically observed with GB rupture.

Case Report

Case 1

A 5-year-old spayed female Chihuahua weighing 3.5 kg was referred to the Veterinary Medical Teaching Hospital of Chungnam National University because of elevated liver enzymes detected during pre-anesthetic blood analysis before dental scaling at a local veterinary clinic. The patient had no specific clinical signs upon admission but had a history of vomiting one month prior to admission. Increased canine C-reactive protein (2.8 mg/L; reference range [RR] = 0.1-1 mg/L) and elevated liver enzymes including alanine aminotransferase (ALT) (677 U/L; RR = 10-125 U/L), alkaline phosphate (ALKP) (1,130 U/L; RR = 23-212 U/L), and gamma-glutamyl transferase (GGT) (32 U/L; RR = 0-11 U/L) were observed on serum biochemistry (Catalyst One Chemistry Analyzer; IDEXX Laboratories Inc.; Westbrook, USA). The serum total bilirubin level was within the normal range.

Abdominal radiography revealed a linear radiopaque structure measuring 4.1 mm in length within the right upper abdomen, which was consistent with the presence of cholecystoliths based on its anatomical location. The gallbladder (GB) was rounded and slightly small (10 × 12 mm) on abdominal ultrasonography (Fig. 1A). Echogenic sludge and multiple hyperechoic cholecystoliths were observed in the GB. Furthermore, the GB wall and adjacent structure, presumed to be the greater omentum, was hyperechoic. Computed tomography revealed a small GB measuring 10.8 × 5.2 × 9.2 mm (length × width × height), with multiple cholecystoliths measuring <2 mm inside (Fig. 2A). Additionally, the cystic duct was dilated to 5 mm, and the common bile duct (CBD) opening into the duodenum measured 4.5 mm in diameter, with no choledoliths observed (Fig. 2B). Based on these findings, the patient was diagnosed with cholecystolithiasis. Considering the potential risk of GB rupture or extrahepatic biliary tract obstruction (EHBO), cholecystectomy was planned.

Figure 1. Small-sized gallbladder on preoperative abdominal ultrasonography in case 1 (A) and case 2 (B).

Figure 2. Preoperative computed tomography in case 1: (A) small sized gallbladder (yellow arrow) with cholecystoliths. (B) Dilated distal common bile duct (white arrow) without choledoliths. Du, duodeneum; S, stomach; L, liver.

The dog was preoxygenated with 100% oxygen using a flow-by technique. Cefazolin sodium (22 mg/kg, IV; Cefazolin; Jonggeundang), maropitant (1 mg/kg, SC; Cerenia; Zoetis), and midazolam (0.2 mg/kg, IV; Midazolam Inj.; Bukwang) were administered as pre-medication. Induction was performed by slow administration of propofol (4 mg/kg IV; Anepol; Hana), followed by endotracheal intubation. Anesthesia was maintained using isoflurane (Ifran; Hana), and constant rate infusion of remifentanil (0.1-0.3 ug/kg/min; Remiva Inj.; Hana) was used for perioperative analgesia. When adequate depth of anesthesia was achieved, the patient was placed in dorsal recumbency for surgery. After midline celiotomy, severe adhesions were observed between the GB and adjacent tissues, including the liver, greater omentum, and diaphragm (Fig. 3A). The GB and adherent tissues were carefully dissected, and a small shrunken GB was observed. After confirming the patency of the CBD, cholecystectomy was performed, followed by sufficient abdominal lavage. A Jackson-Pratt drain was placed and the abdominal wall was routinely closed using the three-layer technique.

Figure 3. Intraoperative images (A, B) and resected gallbladder (GB) (C, D) in two dogs. (A) Ruptured GB adhered to surrounding tissues in case 1. (B) Severely dilated common bile duct (white arrow) in case 2 after cholecystectomy (white asterisk). (C) Perforated GB (yellow arrow) in case 1. (D) Perforated GB (yellow arrow) in case 2. D, diaphragm; Q, quadrate hepatic lobe; GB, gallbladder; P, pancerease; Du, duonedum.

Case 2

A 9-year-old castrated male Poodle weighing 5.3 kg presented with a primary complaint of jaundice and anorexia. The patient was lethargic upon presentation and had a history of vomiting > 10 times in the previous 3 days. Serum biochemical results revealed elevated AST (874 U/L; RR = 0-50 U/L), ALT (over, RR = 10-125 U/L), ALKP (3,500 U/L; RR = 23-212 U/L), and GGT (197 U/L; RR = 0-11 U/L). Serum total bilirubin was also increased (30 mg/dL; RR = 0.0-0.9 mg/dL).

No specific findings were observed on abdominal radiography. Abdominal ultrasonography revealed a small GB measuring 10 × 10 mm, with an irregular GB wall containing echogenic sludge (Fig. 1B). The entire extrahepatic biliary tract, including the CBD, showed dilatation of up to 8.3 mm. No choledocholiths obstructing the biliary tree were observed on ultrasonography. The patient was tentatively diagnosed with EHBO. Emergency cholecystectomy was performed to ensure biliary patency.

General anesthesia was administered using the same protocol as described in Case 1. Following midline celiotomy and an additional paracostal incision, a small GB and severe dilatation of the CBD were confirmed (Fig. 3B). The extensive adhesion between the GB and the quadrate hepatic lobe necessitated partial lobectomy to remove the GB. Additionally, retrograde choledochal catheterization and lavage were performed through an antimesenteric incision in the duodenum to ensure biliary patency. Abdominal lavage was also performed, followed by routine closure of the abdominal wall.

In both cases, a small perforation was observed in the resected GB (Fig. 3C, D). Cholecystoliths were identified within the resected GBs in both dogs. The elevated preoperative liver enzyme levels gradually improved postoperatively in both cases (Table 1). There were no specific complications related to cholecystectomy during the postoperative period, and the dogs were discharged without any complications on postoperative days two (Case 1) and five (Case 2).

Table 1 . Preoperative and postoperative serum biochemistry results in case 1 and case 2.

ParameterReference rangeCase 1Case 2
PreoperativePOD-1POD-4POD-8PreoperativePOD-2POD-8POD-12
AST0-50 (U/L)4411631238742715633
ALT10-125 (U/L)677300153179Over6359343
ALKP23-212 (U/L)1,1303152521793,5003,5002,595786
GGT0-11 (U/L)3250019759303
Total bilirubin0.0-0.9 (mg/dL)0.40.20.30.330.04.12.01.2

POD, postoperative day; AST, aspartate aminotransferase; ALT, alanine aminotransferase; ALP, alkaline phosphatase; GGT, gamma-glutamyl transferase..


Discussion

Gall bladder rupture in dogs can occur due to various causes, although it is more commonly associated with GB disease than with trauma (4,9,14,17). Bile is sterile in normal dogs; therefore, theoretically, the acute phase of bile peritonitis caused by GB rupture is a non-septic condition (10,16). However, depending on the cause of GB rupture, septic bile peritonitis, which has a guarded prognosis compared with sterile bile peritonitis, can develop or progress (9,10,12). Patients suspected of having bile leakage or bile peritonitis are at risk of deterioration at any time. Therefore, prompt surgical intervention is recommended to help improve the prognosis.

The presentation of clinical signs in dogs with gallbladder rupture can range from asymptomatic to severe shock, and is likely associated with factors such as the volume of bile leakage and the presence of bacterial infection (8,9,11). Clinical manifestations are typically nonspecific and include lethargy, anorexia, vomiting, diarrhea, abdominal pain, distention, and jaundice (8,11). Notably, GB rupture should be suspected when abdominal radiography reveals decreased serosal detail, and discontinuity of the GB wall, hyperechoic structures adjacent to the GB, or free fluid accumulation in the abdominal cavity on abdominal ultrasonography (1,5,8). Diagnostic imaging is not infallible, as it lacks both sensitivity and specificity for the definitive diagnosis of GB rupture (1,6). Typically, analyzing the bilirubin concentration of the abdominal fluid obtained through abdominocentesis and comparing it to serum bilirubin levels is an effective method for diagnosing bile leakage resulting from GB rupture (2,8,9).

During the surgery, there was no evidence of bile leakage associated with GB rupture in both our cases. Small-sized GB were observed on abdominal ultrasonography in both dogs. Rupture of the GB is suspected to have resulted from cholecystitis induced by cholecystolithiasis. It is presumed that only a small amount of bile leakage occurred at the time of GB rupture, and that the perforated GB adhered to the surrounding tissues, such as the hepatic lobe, greater omentum, or diaphragm, during the acute phase, preventing continuous leakage and the development of bile peritonitis. In Case 1, there were no specific biochemical findings except for elevated liver enzyme levels. In Case 2, although the dog exhibited vomiting and jaundice, this was believed to be unrelated to the GB rupture and was attributed to EBHO.

Conclusions

Even in cases where there is no evidence or clinical signs related to bile leakage or bile peritonitis, the presence of elevated liver enzymes in biochemistry and a small-sized gallbladder observed on abdominal ultrasonography should raise the suspicion of gallbladder rupture.

Author Contributions

Conceptualization: Moon CH, Jeong SM; Data curation: Moon CH, Kim HJ, Lee WJ; Formal analysis: Moon CH, Kim HJ; Funding acquisition: Jeong SM; Investigation: Moon CH; Supervision: Jeong SM; Writing - original draft: Moon CH; Writing - review & editing: Moon CH, Kwon YS, Jeong JM, Kim DH, Lee HB, Jeong SM.

Source of Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. 2022R1F1A1071251).

Conflicts of Interest

The authors have no conflicting interests.

Fig 1.

Figure 1.Small-sized gallbladder on preoperative abdominal ultrasonography in case 1 (A) and case 2 (B).
Journal of Veterinary Clinics 2023; 40: 452-456https://doi.org/10.17555/jvc.2023.40.6.452

Fig 2.

Figure 2.Preoperative computed tomography in case 1: (A) small sized gallbladder (yellow arrow) with cholecystoliths. (B) Dilated distal common bile duct (white arrow) without choledoliths. Du, duodeneum; S, stomach; L, liver.
Journal of Veterinary Clinics 2023; 40: 452-456https://doi.org/10.17555/jvc.2023.40.6.452

Fig 3.

Figure 3.Intraoperative images (A, B) and resected gallbladder (GB) (C, D) in two dogs. (A) Ruptured GB adhered to surrounding tissues in case 1. (B) Severely dilated common bile duct (white arrow) in case 2 after cholecystectomy (white asterisk). (C) Perforated GB (yellow arrow) in case 1. (D) Perforated GB (yellow arrow) in case 2. D, diaphragm; Q, quadrate hepatic lobe; GB, gallbladder; P, pancerease; Du, duonedum.
Journal of Veterinary Clinics 2023; 40: 452-456https://doi.org/10.17555/jvc.2023.40.6.452

Table 1 Preoperative and postoperative serum biochemistry results in case 1 and case 2

ParameterReference rangeCase 1Case 2
PreoperativePOD-1POD-4POD-8PreoperativePOD-2POD-8POD-12
AST0-50 (U/L)4411631238742715633
ALT10-125 (U/L)677300153179Over6359343
ALKP23-212 (U/L)1,1303152521793,5003,5002,595786
GGT0-11 (U/L)3250019759303
Total bilirubin0.0-0.9 (mg/dL)0.40.20.30.330.04.12.01.2

POD, postoperative day; AST, aspartate aminotransferase; ALT, alanine aminotransferase; ALP, alkaline phosphatase; GGT, gamma-glutamyl transferase.


References

  1. Bargellini P, Orlandi R, Paloni C, Rubini G, Fonti P, Peterson ME, et al. Evaluation of contrast-enhanced ultrasonography as a method for detecting gallbladder necrosis or rupture in dogs. Vet Radiol Ultrasound. 2016; 57: 611-620.
    Pubmed CrossRef
  2. Bohn AA. Analysis of canine peritoneal fluid analysis. Vet Clin North Am Small Anim Pract. 2017; 47: 123-133.
    Pubmed CrossRef
  3. Brömel C, Léveillé R, Scrivani PV, Smeak DD, Podell M, Wagner SO. Gallbladder perforation associated with cholelithiasis and cholecystitis in a dog. J Small Anim Pract. 1998; 39: 541-544.
    Pubmed CrossRef
  4. Church EM, Matthiesen DT. Surgical treatment of 23 dogs with necrotizing cholecystitis. J Am Anim Hosp Assoc. 1988; 24: 305-310.
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Vol.41 No.1 February 2024

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The Korean Society of Veterinary Clinics

pISSN 1598-298X
eISSN 2384-0749

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