Case Study

03_00532 Toby T Ruptured mucocele and bile peritonitis

A 9-year-old NM Cocker Spaniel with a history of lethargy, weight loss, and decreased appetite was presented for evaluation of progressive icterus. On physical examination mildly tense abdomen and icterus were present. Urinalysis showed SG of 1.022, hematuria, proteinuria, and bilirubinuria with E. coli being cultured. Abnormalities on CBC and serum biochemistry were mild lymphopenia, mild neutrophilia, mild hyponatremia and hypokalemia, severely elevated ALT (944), AST (598) and ALP (5088) activity, bilirubin (20.1), CK (1516), and cPL (401).

Sonographic Differential Diagnosis

Ruptured gallbladder mucocele and bile peritonitis. Regional pancreatic inflammation. Immediate exploratory surgery is recommended. Plasma transfusion, coagulation panel and Vitamin K supplementation is recommended prior to intervention. Aggressive antibiotic therapy is recommended. Very guarded prognosis.

Image Interpretation

The liver was moderately enlarged with vacuolar hepatopathy pattern. Hyperechoic surrounding fat was noted in the region of the portal hilus with free fluid. The gallbladder was severely dilated, irregular and echogenic. Loss of detail was noted. This is consistent with perforated gallbladder mucocele. Bile peritonitis was also noted.
The pancreas was heterogenous with mixed echogenic changes extending from the portal hilus.

DX

Ruptured gallbladder mucocele and bile peritonitis.

Outcome

None

Clinical Differential Diagnosis

Liver – acute hepatitis (viral, bacterial, toxins), neoplasia, abscessation
Gall bladder – cholecystitis, mucocele, obstruction (lith, neoplasia, duodenal/pancreatic disease), rupture
Pancreas – pancreatitis, neoplasia