Page 278 - Cote clinical veterinary advisor dogs and cats 4th

Biliary System (Extrahepatic): Surgical Disorders 119.e3

○ Normograde catheterization of the CBD ○ Potential complications of stenting include ADDITIONAL SUGGESTED
to confirm patency obstruction of the stent, premature dis- READINGS
VetBooks.ir the GB is the primary source of the disease • The use of balloon-expandable metallic biliary Amsellem PM, et al: Long-term survival and risk Diseases and Disorders
• Cholecystectomy generally performed when
lodgment, stent migration, and ascending
cholangiohepatitis.
factors associated with biliary surgery in dogs: 34
process or when structural integrity of the
cases (1994-2004). J Am Vet Med Assoc 229:1451-
GB compromised. Indications include
1457, 2006.
term outcomes.
○ GB mucocele stents has been described with good long- Berent A, et al: Initial experience with endoscopic
○ Necrotizing (type I) or acute (type II) • Laparoscopic cholecystectomy can be suc- retrograde cholangiography and endoscopic retro-
cholecystitis cessful for uncomplicated GB diseases. The grade biliary stenting for treatment of extrahepatic
○ Cholelithiasis limited to the GB and/or need for conversion to laparotomy is reported bile duct obstruction in dogs. J Am Vet Med Ass
cystic duct in up to 30% of cases, necessitating the 246:436-446, 2015.
○ Neoplasia of the GB (rare and include surgeon to be familiar with exploratory Buote NJ, et al: Cholecystoenterostomy for treatment
biliary carcinoid tumors and lymphoma) laparotomy. of extrahepatic biliary tract obstruction in cats: 22
cases (1994-2003). J Am Vet Med Assoc 228:1376-
• Cholecystectomy is contraindicated if the 1382, 2006.
patency of the CBD cannot be confirmed. Nutrition/Diet Mayhew PD, et al: Choledochal tube stenting for
• Tube cholecystostomy provides temporary Dietary modification is not necessary after decompression of the extrahepatic portion of the
biliary diversion for patients if definitive cholecystectomy. biliary tract in dogs: 13 cases (2002-2005). J Am
therapy is not immediately available or Vet Med Assoc 228:1209-1214, 2006.
warranted. PROGNOSIS & OUTCOME Mayhew PD, et al: Evaluation of coagulation in dogs
○ Advantage is the option for positive with partial or complete extrahepatic biliary
contrast cholangiography to confirm Cause dependent obstruction by means of thromboelastography. J
Am Vet Med Assoc 242:778-785, 2013.
patency of the CBD before tube removal. • GB mucocele: guarded in the postoperative Mehler SJ: Complications of the extrahepatic biliary
○ Both percutaneous and laparoscopic period but excellent prognosis after discharge surgery in companion animals. Vet Clin North
methods described from hospital Am Small Anim Pract 41:949-967, 2011.
• Choledochotomy should be avoided if an ○ Dogs undergoing elective cholecystectomy Monticelli P, et al: Life-threatening perianaesthetic
alternative procedure exists due to the risk have a better prognosis than dogs that are complications in five cats undergoing biliary tract
of stricture and bile leakage. Indications ill at the time of surgery. surgery: case series and literature review. J Feline
include • Cholecystoenterostomy: neoplastic causes Med Surg 19:717, 2017.
○ Cholelith removal warrant a poor prognosis (14 days median Tamborini A, et al: Bacterial cholangitis, cholecystitis,
○ Incisional biopsy of mural lesions survival time) or both in dogs. J Vet Intern Med 30:1046-1055,
2016.
○ Normograde placement of choledochal Travis B, et al: Clinical use of balloon-expandable
stents PEARLS & CONSIDERATIONS metallic biliary stents for treatment of extrahepatic
• Cholecystoenterostomy is performed when biliary obstruction in 4 dogs and 2 cats [abstract].
patency of the CBD or duodenal papilla is Comments Presented at the ACVS Symposium, Indianapolis,
in question. • Prehepatic and intrahepatic causes of IN, 2017.
○ Cholecystoduodenostomy is more physi- hyperbilirubinemia must be ruled out before
ologic and is preferred to cholecystojeju- surgery of the EHBS. RELATED CLIENT EDUCATION
nostomy. • Cholecystectomy should be performed only SHEETS
○ Tension on the anastomosis site and after confirmation of patency of the CBD
twisting of the cystic duct must be and duodenal papilla. Consent to Perform Abdominal Ultrasound
avoided. • Perioperative hemorrhage is common; assay Consent to Perform Abdominocentesis
○ A 50% contraction of the original stoma coagulation before surgery and have blood Consent to Perform Exploratory Laparotomy
site is expected. products readily available. Consent to Perform General Anesthesia
○ Stoma length should be 2.5-4 cm to avoid
retention of intestinal chyme. Technician Tips AUTHOR: Fredrick S. Pike, DVM, DACVS
○ Ascending cholangiohepatitis is a potential The clinical status of dogs after biliary surgery EDITOR: Keith P. Richter, DVM, MSEL, DACVIM
long-term sequela, often requiring inter- can change rapidly. Frequent re-evaluation is
mittent antibiotic therapy. essential to recognizing changes early, before
• Choledochal stenting is generally performed any complications can progress.
for temporary biliary diversion.
○ The small size of the canine and feline SUGGESTED READING
duodenal papilla and the intramural Boothe HW: Current concepts in hepatobiliary
component of the CBD limit stenting surgery. Vet Clin North Am Small Anim Pract
options. 45:463-475, 2015.

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