Pichard Diane, Bernard Pauline, Fenet Marion, Garnier Paul, Schoffit Sarah, Manzoni Sarah, Benchekroun Ghita, Manassero Mathieu, Freiche Valérie
Ecole Nationale Vétérinaire d'Alfort, CHUVA, Service de Médecine Interne, Maisons-Alfort, France.
Ecole Nationale Vétérinaire de Toulouse, CHUV-Ac, Service de Médecine Interne, Toulouse, France.
JFMS Open Rep. 2024 Jul 25;10(2):20551169241258635. doi: 10.1177/20551169241258635. eCollection 2024 Jul-Dec.
A 10-year-old neutered female domestic shorthair cat was presented to our hospital with a 2-day history of anorexia, vomiting and lethargy. The biochemistry panel revealed increased hepatic enzyme activity and serum amyloid A concentration. Haematological values were within reference intervals. An abdominal ultrasound identified a hyperechoic spindle-shaped structure within the common bile duct and a suspected secondary subobstruction, associated with signs of intra- and extrahepatic biliary tract inflammation. During hospitalisation, the cat developed severe and sustained ionised hypercalcaemia. Exploratory surgery was elected as a result of the lack of clinical improvement, despite supportive treatment and suspected retrograde migration of the spindle-shaped structure. Two grass awns were extracted at the junction of an extrahepatic duct and the common bile duct via choledochotomy using intraoperative ultrasound guidance. A stent was then placed in the bile duct to prevent subsequent bile leakage. Histopathology of the liver revealed a moderate neutrophilic and lymphoplasmacytic inflammation with rare bacterial colonies. was cultured from a bile sample. No specific cause of hypercalcaemia was identified. The cat recovered uneventfully from surgery. Hepatic enzyme activities and hypercalcaemia progressively decreased within a few weeks after surgery and remained within the reference intervals without treatment. Therefore, hypercalcaemia was suspected to be secondary to a foreign body-related granulomatous reaction.
To our knowledge, only one other feline case report of biliary tract obstruction secondary to a biliary foreign body has been described in the literature. This is also the first case reporting the use of intraoperative ultrasound to localise a vegetal foreign body within the biliary tract of a cat. This case is also unique because of the onset of hypercalcaemia suspected to be secondary to a foreign body-related granulomatous reaction.
一只10岁已绝育的雌性家养短毛猫因厌食、呕吐和嗜睡2天被送至我院。生化检查显示肝酶活性和血清淀粉样蛋白A浓度升高。血液学指标在参考区间内。腹部超声检查发现胆总管内有一个高回声纺锤形结构，怀疑存在继发性部分梗阻，并伴有肝内外胆管炎症迹象。住院期间，该猫出现严重且持续的离子化高钙血症。尽管进行了支持治疗且怀疑纺锤形结构逆行迁移，但由于临床症状无改善，遂选择进行 exploratory surgery（此处原文有误，推测应为“探查性手术”）。通过术中超声引导经胆总管切开术在肝外胆管与胆总管交界处取出两根草芒。然后在胆管内放置支架以防止随后的胆汁渗漏。肝脏组织病理学检查显示有中度中性粒细胞和淋巴细胞 - 浆细胞炎症，有罕见细菌菌落。从胆汁样本中培养出了（此处原文缺失培养出的内容）。未发现高钙血症的具体病因。该猫手术后恢复顺利。术后几周内肝酶活性和高钙血症逐渐下降，未经治疗仍保持在参考区间内。因此，怀疑高钙血症继发于异物相关的肉芽肿反应。
据我们所知，文献中仅描述了另一例猫因胆管异物导致胆管梗阻的病例报告。这也是首例报告在猫的胆管内使用术中超声定位植物性异物的病例。该病例还因其怀疑高钙血症继发于异物相关的肉芽肿反应而独特。
