Article

Choledocholithiasis in a dog coledocolitiasi in un cane

01/2007;
Source: OAI

ABSTRACT SUMMARY
A 14-year-old, intact male Siberian Husky was examined because of recurrence of
inappetence, weakness and vomiting. Results of a CBC showed mild normocytic normocromic
anaemia, hypereosinophilia with activated monocytes. Increase of ALT, AST, ALP, GGT,
cholesterol and bilirubin supported a diagnosis of hepatobiliary disease. Abdominal ultrasound
evaluation showed an incomplete extrahepatic biliary tract obstruction (EHBO), with suspected
cholelithiasis and cholecystitis. Any evidence of radiopaque stone was showed at abdominal
radiography.
A cause to the incomplete response to medical treatment with amoxicilline and clavulanic
acid, ursodeoxycholic acid, vitamin E and silymarin, biliary surgery was performed, showing
a hugely dilated biliary tree and several stones in the common bile duct. The choleliths were
removed, using a combined approach through common bile duct, gallbladder and duodenum.
During surgery a biopsy sample was collected, and histologically a diagnosis of chronic
cholangitis with diffuse cholestasis and periportal fibrosis was formulated. The bacterbilia was
not demonstrate to cultural and cytologic exam. Any complication was revealed in postoperative
time; the clinical condition, CBC and serum biochemical profile were normal during the 8-
month follow-up period.
Stones usually form in the gallbladder, but sometimes they can form directly in the
common bile duct or move here from the biliary tree. Multiple small stones, causing incomplete
obstruction, with a major one of 1,5x7mm, were removed from the final tract of the common
bile duct in this dog.

RIASSUNTO
Un Siberian Husky, maschio intero di 14 anni, è stato portato alla nostra attenzione per
episodi ricorrenti di disappetenza, abbattimento e vomito. L’emogramma rivelava la presenza
di una lieve anemia normocitica normocromica, accompagnata da eosinofilia e monociti
attivati. L’incremento di ALT, AST, ALP, GGT, colesterolo e bilirubina, evidenziabili nel
profilo biochimico, supportavano l’ipotesi diagnostica di una patologia epatobiliare. L’ecografia
addominale confermava la presenza di un’ostruzione incompleta delle vie biliari extraepatiche,
con sospette colelitiasi e colecistite. Il radiogramma addominale non evidenziava radiopacità
sospette nell’area epatica.
In seguito alla parziale risposta al trattamento medico a base di amoxicillina e acido
clavulanico, acido ursodeossicolico, vitamina E e silimarina, il paziente veniva sottoposto a
terapia chirurgica. La laparotomia permetteva di confermare la dilatazione delle vie biliari e
metteva in evidenza la presenza di diversi coleliti nel coledoco. I coleliti venivano rimossi con
un approccio combinato attraverso il coledoco, la colecisti ed il duodeno. In sede chirurgica
venivano eseguiti campionamenti bioptici del fegato e della colecisti; l’esame istologico
formulava diagnosi di colangite cronica con colestasi diffusa e fibrosi periportale. La bile
risultava negativa per batteri sia all’esame citologico che colturale. Nel periodo postoperatorio
non sono comparse complicazioni e durante il follow up di 8 mesi si è assistito ad una
normalizzazione stabile dell’emogramma e del profilo biochimico.
I coleliti solitamente si formano nella colecisti, ma in alcuni casi si possono formare nel
coledoco o arrivare in questa sede dalle vie biliari superiori. In questo cane, nel tratto finale del
coledoco, sono stati rimossi alcuni piccoli coleliti ed un calcolo di 1,5x7 mm che causavano una
incompleta ostruzione delle vie biliari.

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