Preoperative serum C-reactive protein concentration can be used to detect gallbladder rupture in dogs with gallbladder mucocele

OBJECTIVE To determine whether serum C-reactive protein (CRP) concentration could be used to detect gallbladder rupture (GBR) prior to surgery in dogs undergoing cholecystectomy for treatment of gallbladder mucocele (GBM). ANIMALS 45 dogs that underwent cholecystectomy because of GBM at a companion animal referral hospital from 2017 to 2020. PROCEDURES Electronic medical records were reviewed, and dogs were included if serum CRP concentration had been measured within 24 hours prior to cholecystectomy. Dogs were grouped as to whether the gallbladder was found to be ruptured or intact during surgery. Accuracy of using preoperative CRP concentration to predict GBR was compared with accuracy of abdominal ultrasonography and other preoperative blood tests. RESULTS GBR was present in 15 dogs at the time of surgery. Median preoperative CRP concentration was significantly higher in dogs with GBR (15.1 mg/dL; interquartile range, 7.4 to 16.8 mg/dL) than in dogs with an intact gallbladder (2.65 mg/dL; interquartile range, 0.97 to 13.4 mg/dL). Sensitivity, specificity, and accuracy of using preoperative CRP concentration to predict GBR were 100%, 67%, and 78%, respectively. CLINICAL RELEVANCE Measurement of preoperative CRP concentration provided excellent sensitivity and moderate specificity for detection of GBR in dogs undergoing cholecystectomy because of GBM. Accuracy of using preoperative CRP concentration for detection of GBR was not superior to the accuracy of preoperative abdominal ultrasonography. However, when CRP concentration was combined with results of ultrasonography, the sensitivity, specificity, and accuracy for detection of GBR were 100%, 93%, and 96%, respectively.

Surgical case report—acalculous hemorrhagic cholecystitis

Haemorrhagic cholecystitis is a seldom seen cause of right upper quadrant pain that can result in gallbladder rupture, massive intraperitoneal haemorrhage and death if untreated. Haemorrhagic cholecystitis is usually seen in the presence of cholelithiasis, malignancy, trauma and coagulopathies. Here, we present the unusual case of an elderly man presenting with acalculous haemorrhagic cholecystitis, who was successfully treated with laparoscopic cholecystectomy. We review the radiological and laparoscopic findings of haemorrhagic acalculous cholecystitis. This case highlights the importance of prudent use of radiological imaging to differentiate haemorrhagic cholecystitis from alternate pathology and early surgical intervention to avoid massive intraperitoneal haemorrhage and the high mortality with which it is associated.

PERFORACION TRAUMATICA AISLADA DE LA VESICULA BILIAR: REVISION DE LA LITERATURA ACTUAL Y REPORTE DE UN CASO

Introducción: La lesión de la vesícula biliar secundaria a trauma abdominal cerrado constituye un evento infrecuente de perforación traumática de ella, de presentación tardía; revisamos la literatura científica actualmente disponible y además describimos un caso. Materiales y Método: Utilizando la plataforma PubMed se buscan las siguientes palabras clave: “Blunt abdominal trauma”. Se seleccionan las series con lesiones de la vesícula biliar: “Traumatic gallbladder rupture”. Se seleccionan los reportes de lesiones aisladas de la vesícula biliar: “Isolated gallbladder rupture”. Se seleccionan los reportes de presentación tardía de lesiones aisladas de la vesícula biliar: “Delayed presentation of isolated gallbladder rupture”. Resultados: De todas estas publicaciones se seleccionan las que a criterio de los autores son relevantes para el presente caso. Discusión: La mayoría de las perforaciones de la vesícula biliar se producen en vesículas sanas de paredes delgadas distendidas por el ayuno o el consumo de alcohol. No existe una presentación clínica clásica. Los estudios imagenológicos son inespecíficos y se llega al diagnóstico definitivo durante la exploración quirúrgica. El tratamiento de esta lesión es la colecistectomía. Conclusión: El diagnóstico no es fácil pero la resolución es relativamente simple y el pronóstico es bueno. El presente caso ilustra este tipo de lesiones en pacientes con trauma abdominal cerrado

Septicaemia due to a Proteus infection in a Humboldt penguin (Spheniscus humboldti)

A 2-year-old male Humboldt penguin (Spheniscus humboldti) died after a very brief period of illness at a zoo aquarium; the penguin showed sudden depression, anorexia, dyspnoea, and had recurrent melena a day prior to death. The gross examination revealed an extensive bilious effusion in the abdominal cavity due to a gallbladder rupture. Moreover, abscess formation, purulent exudate, severe congestion, and haemorrhages were observed in the trachea and parenchymal organs such as the kidneys and the lungs. A histopathological examination revealed a fibrin deposition with a severe haemorrhage and secondary infiltration of chronic-active inflammatory cells in the parabronchi, atria, and air capillaries and blood vessels of the lungs as well as in most of the parenchymal organs. Moreover, Gram-negative bacilli were found in the lumen of the gastrointestinal tracts including the small and large intestines accompanied by severe epithelial necrosis and the capsule of the liver. Especially, bile pigments were microscopically observed in the whole liver, which indicated a gallbladder rupture. Samples collected from the trachea, lungs, and blood were cultured on a blood agar, and the pure colonies of Proteus genus were isolated. Proteus mirabilis, P. penneri, P. vulgaris, and P. cibarius were identified with polymerase chain reaction (PCR). As a result, the diagnosis was confirmed as Proteus septicaemia. To our knowledge, this is the first report of concomitant infection by different Proteus species that eventually resulted in septicaemia in a Humboldt penguin, and it will provide valuable information for zoo veterinarians for its diagnosis as well, since Humboldt penguins are the most widely found penguins in zoos and Proteus septicaemia in the penguins has, to the best of our knowledge, not been reported as yet.