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Gallbladder Rupture

Clinician's Brief (Capsule)

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A 6-year-old spayed albino ferret (Mustela putorius) presented with a 2-day history of lethargy and anorexia. There was marked cranial abdominal pain. Significant neutrophilic leukocytosis and hypoalbuminemia were noted on blood work. Liver enzymes were within normal limits. IV fluids, 5 mg/kg marbofloxacin PO q12h, 20 mg/kg metronidazole IV q12h, 4 mg/kg ranitidine IV q8h, and 0.1 mg/kg morphine SC q6h were initiated. Abdominal ultrasound revealed bile duct inflammation, hyperechogenicity of abdominal fat and peritoneum, peritoneal effusion, and thickening and hyperechogenicity of the biliary tree. Gas bubbles were observed in the gallbladder. Fine-needle aspirate of peritoneal fluid produced yellow-to-green turbid liquid, with cytology indicative of bile peritonitis.

Cholecystectomy is recommended for gallbladder rupture in mammals. Surgical technique in ferrets is similar to that in other mammals. Several gallbladder perforations were seen in this ferret. The gallbladder was removed and submitted for culture and histopathology and liver biopsy. There was pure growth of Pseudomonas aeruginosa. Histopathologic findings included severe lymphocytic and granulomatous cholecystitis with cystic glandular hyperplasia of the gallbladder mucosa and marked lymphocytic cholangiohepatitis. The ferret showed clinical improvement and was eating on its own the day after surgery. Meloxicam (0.2 mg/kg PO daily) was given for 1 week, and antibiotics were continued for 4 weeks.

Commentary

This well-written, excellently referenced article reminds me of the frequency of biliary disease in the ferret compared to other species. Over the years, I have encountered obstruction, choleliths, bacterial infection, coccidiosis, mucosal hyperplasia (very common), and neoplasia (usually metastatic, and most often malignant lymphoma). As a pathologist, I want to draw attention to the histologic finding of a lymphocytic cholangiohepatitis in this case—a common finding in ferret liver biopsies. Although in this case it was associated with gallbladder disease, in ferrets (especially older ferrets), it is most often seen in association with inflammatory bowel disease. When I see it, I think bowel inflammation first, gallbladder second.—Bruce Williams, DVM, DACVP

References

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