Case Study

Gallbladder mucocele in an 11yr old, MN Dachshund.

Dachshund, MN, 11 years, 9.31 lbs. history of elevated liver values, increased WBCs and fever on 6/6/16 – treated with antibiotics and values declined, recheck BW found liver values increasing again. Phenobarbital. Last Phenobarbital level = 7.0 (15-45). ALT 290, ALKP 1173, GGT 23. Radiograph Findings: NSF

DX

Gallbladder mucocele with bile peritonitis

Sonographic Differential Diagnosis

Severe ruptured gallbladder mucocele and bile peritonitis. Plasma transfusion, plasma expanders, broad spectrum antibiotics with immediate cholecystectomy and common bile duct lavage is recommended. The common bile duct was not visualized owing to the peritonitis. Flushing of the common bile duct at the time of surgery is recommended. Very guarded prognosis.

Image Interpretation

The liver itself was mildly heterogenous and slightly swollen. The gallbladder in this patient was double layered with a kiwi type appearance and striating bile. Pericapsular inflammatory pattern was noted along with a double layered wall. Complete disruption of the gallbladder wall was noted. The gallbladder measured 6.8 x 4.75 cm. The common bile duct presented a minor amount of debris, yet was normal in size at 0.5 cm. Regional inflammation was noted throughout the gallbladder. This is consistent with bile peritonitis.