Cholecystoduodenostomy in Common Bile Duct Leakage and Bile Peritonitis in 3-Month-Old Siberian
Bile peritonitis is a severe, nonseptic inflammatory response caused by leakage of bile, may occur with traumatic rupture of the extrahepatic biliary tree or secondary to necrotizing cholecystitis or chronic obstruction. Cholecystoduodenostomy is one of the procedures used to repair common bile duct injury.
To identify and repair the leakage site of biliary tree and divert bile flow.
A 3-month-old Siberian was diagnosed with bile peritonitis that may have been caused by extrahepatic biliary tree injury with presenting ascites and anorexia. Blood profile and ultrasonography were assessed. Abdominal paracentesis and fluid analysis were performed. The peritoneal effusion was green colour and total bilirubin level was higher than in serum. An abdominal exploratory was performed on the patient which found adhesion, fibrosis and a leakage site at common bile duct. Leakage site was sutured, cholecystoduodenostomy and abdominal drainage were performed.
The patient was admitted for fluid therapy and ABO therapy. Peritonitis, bile leakage and dehiscence were monitored by colour and turbidity of the peritoneal fluid. The patient had hypoalbuminemia after surgery, was fed a low-fat diet, did not show leakage or dehiscence and was discharged 10 days after surgery.
Bile peritonitis in a young dog is likely caused by trauma. Bile flow diversion is recommended when the common bile duct injury is severe and distal to the entrance of the hepatic duct. In this case report, it was small and the leakage site had adhesion and fibrosis and consequently cholecystoduodenostomy was performed. Ascending cholangiohepatitis may occur in the long term.