Case Study

Acute on chronic pancreatitis causing extra-hepatic bile duct obstruction in a 12 year old MN Chihuahua mix

A 12-year-old male neutered Chihuahua Mix was presented for evaluation of acute onset vomiting. Additional history included seizure activity that was well controlled. Blood work one month ago had been within reference range. Current abnormalities on CBC and serum biochemistry included band neutrophilia, elevated total bilirubin and cholesterol, and severely elevated ALP and ALT activity.

DX

Acute on chronic pancreatitis with extra-hepatic common bile duct obstruction

Sonographic Differential Diagnosis

Acute on chronic pancreatitis with likely abscessation or necrosis and post hepatic obstruction.

Image Interpretation

The pancreas presented heterogenous changes and measured approximately 4.0 cm with mixed hypoechoic and hyperechoic areas. This is consistent with chronic active pancreatitis. The pancreatic presentation extended to the base of the pancreas and enveloped the pyloric outflow and enveloped the common bile duct causing post hepatic obstruction. A focal portion of the left base of the pancreas revealed a hypoechoic area which is consistent with necrosis or potential abscessation. Multiple adhesions of the pancreas were noted and attached to the serosa of the pyloric outflow. The gallbladder was distended with suspended debris. The upper duodenum was thickened, but there was no loss of detail was noted. However, duodenal spasming was noted.

Outcome

None

Clinical Differential Diagnosis

Hepatic disease: acute hepatitis (viral, bacterial, toxins), neoplasia, drug reaction; Gall bladder disease: cholecystitis, mucocele; Pancreatic disease: acute pancreatitis, neoplasia, abscessation; Peritonitis.