Diagnosis and treatment of a septic gall bladder in a Standard Poodle

Abstract

An eleven year old male castrate[d] Standard poodle presented for evaluation of a greater than one year history of elevated liver enzymes (ALT, AST, ALP, GGT) and hypercholesterolemia with no associated clinical signs of disease. Imaging revealed a mildly distended gall bladder which contained biliary sludge and choleliths. Additionally, the gall bladder was shown to be hypomotile by an ultransonographic serial contractility examination. The organ was found to be diffusely thickened with irregular walls at the time of exploratory lapartotomy. Concretions were palpable in the lumen, the cystic duct was irregularly thickened, and aspirated bile was watery, thin and amber-colored. A cholecystectomy was performed and a multi-drug resistant Enterococcus faecium species was cultured. Histopathology was consistent with an infectious and chronic inflammmatory etiology. It is suspected that an ascending gastrointestinal infection is responsible for this clinically unapparent septic cholecystitis. This case demonstrates the utility and importance of routine blood testing in detecting asymptomatic disease.