Feline cholecystitis and acute neutrophilic cholangitis: clinical findings, bacterial isolates and response to treatment in six cases

Abstract

Clinicopathological findings from six cats with confirmed cholecystitis or acute neutrophilic cholangitis are presented. Historical findings included lethargy and anorexia or inappetence of up to five days duration. On physical examination all cats were pyrexic and four out of six were jaundiced and had cranial abdominal pain. Bile samples were obtained by cholecystocentesis at exploratory coeliotomy (two cases) or by percutaneous, ultrasound-guided cholecystocentesis (four cases). Gall bladder rupture and bile peritonitis occurred subsequent to ultrasound-guided cholecystocentesis in one case. The most common bacterial isolate was Escherichia coli (four cases); E coli was isolated alone in two cases, in combination with a Streptococcus species (one case) and in combination with a Clostridium species (one case). Streptococcus species alone was isolated from one case, as was Salmonella enterica serovar Typhimurium. The latter is the first reported case of Salmonella-associated cholecystitis in a cat. Concurrent pancreatic or intestinal disease was detected histologically in three cases. All cases were treated with antimicrobials based on in vitro susceptibility results. Treatment was successful in five cases. One cat with concurrent diffuse epitheliotropic intestinal lymphoma was euthanased. Percutaneous ultrasound-guided cholecystocentesis is an effective, minimally-invasive technique enabling identification of bacterial isolates in cats with inflammatory hepatobiliary disease.

Fig 1

Ultrasonographic image of the gall bladder from case 1. The gall bladder wall is thickened (2.6 mm diameter) and the lumen contains dependant, echogenic, particulate matter (‘sludge’).

Fig 2

Aspirate of purulent bile from gall bladder of case 1 obtained by percutaneous cholecystocentesis.

Fig 3

Gram-stained smear from purulent bile from case 1 revealed chains of Gram-negative rods, which were identified as Salmonella enterica serovar Typhimurium.

Fig 4

Diff-Quik stained smear of bile from case 3 revealed degenerate inflammatory cells and pleomorphic bacterial rods and cocci.

Fig 5

Ultrasonographically the mucosa of the gall bladder in case 6 was irregular and ‘palisade’ in appearance.