White bile syndrome is characterised by colourless viscid bile accumulation in the gall bladder and/or bile ducts. In human medicine this syndrome has been described as a consequence of extrahepatic biliary duct obstruction (EHBDO) associated with resorption of bile pigments. To the author’s knowledge the colourless viscid fluid in the gall bladder has not been previously documented in dogs.
Here we describe this rare phenomenon in a 7-year-old spayed female dachshund presented for icterus of 7 weeks duration and acholic faeces.
Serum biochemistry revealed hyperbilirubinemia with marked increase in ALT, ALP, AST and GGT suggesting cholestatic hepatobiliary disease. Because of severe gall bladder changes during abdominal ultrasound, a laparotomy with cholecystectomy and wedge liver biopsy were performed. No obvious cause of obstruction was found. Bile obtained via cholecystocentesis was atypically colourless and viscid.
Cytology of the gall bladder contents revealed moderate purulent inflammation with a massive population of predominantly rod-shaped bacteria, occasionally phagocytized. Bile culture showed confluent growth of E. coli (++++). Histopathology found moderate to marked granulomatous hepatitis and chronic lymphoplasmacytic cholecystitis with cholelithiasis. The dog was treated with antibiotics (amoxicillin/clavulanic acid, metronidazole and enrofloxacin) in order to eliminate E. coli infection and supportive drugs (S-adenosylmethionine, silymarin, ursodiol, famotidine).
Acholic faeces resolved, however icterus persisted. Moreover signs of liver insufficiency, hepatic encephalopathy and portal hypertension have developed.
Financial support was provided by IGA VFU Brno 129/2016/FVL.