Biliary mucoceles in dogs | VETgirl Veterinary Continuing Education Videos
In this VETgirl online veterinary CE video, we discuss the disease that internists love to cut and surgeons love to medically manage: the biliary mucocele. Biliary mucoceles can develop from abnormal gallbladder mucosal cells, or secondarily to abnormal gallbladder motility. Predisposing factors towards development of biliary mucoceles include hypothyroidism and hyperadrenocorticism. Although relatively uncommon in dogs, biliary mucoceles remain an important differential to dogs whose symptoms include vomiting, lethargy, anorexia, icterus, and abdominal pain. Gallbladder mucoceles may also be found incidentally on routine ultrasound. Mucoceles are comprised of inspissated bile and mucus, leading to gallbladder distension, possible extrahepatic biliary obstruction, gall bladder rupture, and secondary bile peritonitis.
Diagnosis of a mucocele is generally based on clinicopathologic testing and abdominal ultrasound, and reveal elevations in liver enzymes, hyperbilirubinemia, and evidence of gallbladder distension with an intraluminal mass-effect with a characteristic stellate pattern known as the “kiwi sign.” Fluid may form a hypo- to anechoic ring around the gallbladder secondary to early rupture of the gallbladder and bile peritonitis. In general, VETgirl doesn’t advocate for aspirating the gall bladder in these situations due to risk of septic bile peritonitis.
Cholecystectomy is the treatment of choice for biliary mucoceles. If the patient is symptomatic for the mucocele, emergent surgery is recommended. Ideally, surgery should not be delayed due to the risk of gallbladder rupture. Medical management with ursodiol and/or antimicrobial therapy may be effective, but should be done so only with close serial monitoring. Overall, the prognosis for dogs with biliary mucoceles is relatively good if recognized early and surgical intervention is taken; the prognosis is poorer in dogs requiring emergency surgery secondary to bile peritonitis.