Diane Pichard, Pauline Bernard, Marion Fenet, Paul Garnier, Sarah Schoffit, Sarah Manzoni, Ghita Benchekroun, Mathieu Manassero, Valérie Freiche
Journal of Feline Medicine and Surgery Open Reports 10 (2), (2 August 2024) https://doi.org/10.1177/20551169241258635
KEYWORDS: abdominal ultrasonography, foreign body, grass awn, intraoperative ultrasound guidance, choledochotomy, choledochal stenting
Case summary A 10-year-old neutered female domestic shorthair cat was presented to our hospital with a 2-day history of anorexia, vomiting and lethargy. The biochemistry panel revealed increased hepatic enzyme activity and serum amyloid A concentration. Haematological values were within reference intervals. An abdominal ultrasound identified a hyperechoic spindle-shaped structure within the common bile duct and a suspected secondary subobstruction, associated with signs of intra- and extrahepatic biliary tract inflammation. During hospitalisation, the cat developed severe and sustained ionised hypercalcaemia. Exploratory surgery was elected as a result of the lack of clinical improvement, despite supportive treatment and suspected retrograde migration of the spindle-shaped structure. Two grass awns were extracted at the junction of an extrahepatic duct and the common bile duct via choledochotomy using intraoperative ultrasound guidance. A stent was then placed in the bile duct to prevent subsequent bile leakage. Histopathology of the liver revealed a moderate neutrophilic and lymphoplasmacytic inflammation with rare bacterial colonies. Escherichia coli was cultured from a bile sample. No specific cause of hypercalcaemia was identified. The cat recovered uneventfully from surgery. Hepatic enzyme activities and hypercalcaemia progressively decreased within a few weeks after surgery and remained within the reference intervals without treatment. Therefore, hypercalcaemia was suspected to be secondary to a foreign body-related granulomatous reaction.
Relevance and novel information To our knowledge, only one other feline case report of biliary tract obstruction secondary to a biliary foreign body has been described in the literature. This is also the first case reporting the use of intraoperative ultrasound to localise a vegetal foreign body within the biliary tract of a cat. This case is also unique because of the onset of hypercalcaemia suspected to be secondary to a foreign body-related granulomatous reaction.