Freddie’s gallbladder mucocele
Case summary:
Freddie, an 8 year old Cockapoo, presented to the internal medicine service with a 4-day history of lethargy and gastrointestinal signs. A diagnosis of a ruptured gallbladder mucocele – a serious condition caused by the buildup of thick mucus in the gallbladder – was made on an ultrasound scan and Freddie was transferred to the soft tissue surgery team later the same day. Freddie underwent an open cholecystectomy and placement of a central venous line and oesophagostomy feeding tube. He remained hospitalised for 3 days, after which he was stable enough to be discharged. Since recuperating at home, Freddie has made a complete recovery.
Patient and issue summary:
Freddie presented to us on 25th November 2024 with a 4-day history of lethargy with vacant episodes, hyporexia and intermittent vomiting. Investigations prior to referral documented mild to moderately increased liver enzyme activities and mild hyperbilirubinaemia (18g/L, RI<16). Point of care abdominal ultrasonography raised suspicion of a gallbladder mucocele. Fluid therapy, analgesia (methadone, lidocaine and paracetamol) and anti-nausea medications (maropitant) were provided prior to referral.
Clinical examination and diagnosis:
Freddie presented non-ambulatory, quiet, poorly responsive, dehydrated and with signs of abdominal pain. Following stabilisation an abdominal ultrasound scan revealed a mature gallbladder mucocele with suspected wall rupture and associated peritoneal fluid and pneumoperitoneum.
Diagnostic investigations from Abdominal Ultrasonography:
- Mature gallbladder mucocele with suspected wall rupture and associated peritoneal fluid and pneumoperitoneum
- Mild hepatomegaly with rounded margins and heterogeneous echotexture, likely reactive
- Bilateral chronic renal changes (uncertain significance)
- Normal sized adrenal glands
- No ultrasonographic evidence of pancreatitis/enteritis.
Treatment:
Following the above investigations, Freddie was transferred to the care of the Soft Tissue Surgery Department. Under general anaesthesia Freddie was prepared for surgery. Via a routine midline celiotomy the abdomen was explored revealing a low-volume grossly haemorrhagic effusion and immature adhesions between the omentum and gallbladder and the liver and diaphragm. A cholecystectomy was performed utilising a subserosal dissection technique. A rupture of the gallbladder wall cranially into the right medial and quadrate liver lobes was revealed with focal hepatic inflammation and blood clots confirming this to be pre-existing rather than iatrogenic.
Normograde flushing of the common bile duct was performed successfully. A liver biopsy was obtained, the abdomen was lavaged and closed routinely with monocryl intradermal sutures placed in the skin. An oesophagostomy tube was placed routinely in the left side of the neck.
Outcome and recovery:
Freddie recovered well from his anaesthesia. He remained hospitalised for ongoing monitoring and support until 28th November at which point, he was bright, comfortable and tolerating tube feeds well and had started eating voluntarily.
Since being discharged from the hospital Freddie has made a full recovery, his appetite is better than ever before and he appears to have a new zest for life. This case is a fantastic example of seamless collaboration across departments, illustrating the strength of a multidisciplinary approach to patient care.
Quotes/testimonials:
Owner quote: ‘Freddie’s doing really well, he’s seems to have a new lease of life…like a puppy again, it’s quite funny seeing him doing a few zoomies!’
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