Case Of the Month

Post-Hepatic Obstruction With Chronic Cholangitis In A 12-Year-Old FS Poodle Mix: Our Case Of the Month 2019

The patient was presented for painful abdomen, pyrexia, vomiting, and anorexia. After 12 hours on IVF and supportive care the patient’s pyrexia resolved and there was no further vomiting. A painful abdomen persisted and mild icterus was evident in both the sclera and mucous membranes. The patient was treated with Cerenia, Unasyn, Metronidazole, Gabapentin, and Famotidine. Blood chemistry found AST 70, ALT 553, ALK. Phos. 8162, GGT 46, T. Bili. 7.2, K 3.4, Chol. 720, Trig. 609, amylase 2038, PSL 697. Urine specific gravity 1.011, proteinuria 2+, bilirubinuria 3+.

DX

Common bile duct calculus. Post hepatic obstruction with chronic cholangitis. Mild potential for common bile duct neoplasia with post hepatic obstruction and hepatic remodeling.

Outcome

Surgical intervention is recommended in this patient with expectations towards bile duct redirection and removal of the calculus. However, the last 2.0 cm of the common bile duct does not look healthy owing to chronic inflammation and likely stricturing. There was no overt evidence of neoplasia; however, there is a minor potential for distal common bile duct neoplasia, yet not suspected.

Image Interpretation

The liver revealed coarse architecture and increased portal markings. Gallbladder polyps and calculi were noted. The common bile duct was dilated to 0.6 cm. A shadowing structure was noted at the termination of the common bile duct with tissue thickening or mucoduct personation in the last 2.0 cm of the common bile duct prior to the duodenal papilla. The echotexture of the sludge and shadowing material in the common bile duct would be most consistent with calculus and concurrent thickening of the common bile duct with inflammation. Expansive masses were not present. Acoustic shadowing was noted. The calculus measured approximately 0.4 cm. Grouping of calculi measured approximately 1.0 cm.