Diagnostic Imaging, Tufts University Cummings School of Veterinary Medicine, North Grafton, MA, USA.
Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, USA.
J Feline Med Surg. 2021 Feb;23(2):194-202. doi: 10.1177/1098612X20921062. Epub 2020 May 21.
This case series describes the postoperative ultrasonographic findings in six cats that underwent a cholecystoduodenostomy as treatment for extrahepatic biliary obstruction. The surgery site was identified in all six cats, most often within the right cranial abdomen as a thick-walled gall bladder, with a broad-based connection to the descending duodenum. Postoperatively, the biliary tree often remained distended, similar to its preoperative appearance. Recurrent extrahepatic biliary obstruction was suspected in three cats with worsening hyperbilirubinemia. Common bile duct distension was progressive in one of these cats and unchanged in another, but improved in the third. Intrahepatic bile duct distension resolved in one cat following surgery but reappeared with suspected recurrent biliary obstruction. In two cats, progressive echogenic biliary contents were associated with locally aggressive cholangiocarcinoma. Our findings suggest that in cats with cholecystoduodenostomy and progressive increases in hyperbilirubinemia following surgery, progressive or recurrent biliary distension and/or progressive echogenic biliary contents should prompt further investigation.
Biliary diversion surgery in cats is associated with high morbidity and mortality. The ultrasonographic appearance of a postoperative cholecystoduodenostomy site has not been described, making differentiation of the expected appearance from postoperative abnormalities difficult. The goal of this study was to determine the expected ultrasonographic appearance, in order to assist in managing cats with recurrent, persistent or worsening clinical signs and biochemical abnormalities following surgery.
本病例系列描述了 6 只接受胆囊十二指肠吻合术治疗肝外胆管阻塞的猫的术后超声表现。在所有 6 只猫中，均能识别手术部位，最常见于右颅腹部的厚壁胆囊，与降十二指肠呈宽基底连接。术后，胆管树通常仍保持扩张，类似于术前外观。3 只猫因反复出现肝外胆管阻塞和高胆红素血症而怀疑复发。其中一只猫的胆总管扩张呈进行性加重，另一只猫无变化，而第三只猫则有所改善。1 只猫的肝内胆管扩张在手术后消失，但怀疑复发时再次出现。在 2 只猫中，进行性回声增强的胆管内容物与局部侵袭性胆管癌有关。我们的研究结果表明，对于接受胆囊十二指肠吻合术的猫，如果术后胆红素升高持续进展，出现进行性或复发性胆管扩张和/或进行性回声增强的胆管内容物，应进一步进行调查。
猫的胆管分流术相关发病率和死亡率较高。术后胆囊十二指肠吻合部位的超声表现尚未描述，使得难以区分预期的外观和术后异常。本研究的目的是确定预期的超声表现，以便在手术后出现持续或加重的临床症状和生化异常的猫中进行管理。
