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==Introduction==

 

==Description==

Rupture of the biliary tract is a severe disease that results in localised or diffuse chemical [[Peritonitis|peritonitis]] as bile leaks into the abdomen.  If the biliary tract is infected, the peritonitis will be septic from the outset.  If the tract is not infected at the point of rupture, the peritonitis may still become septic as the presence of bile in the peritoneal cavity reduces the integrity of the gut mucosal barrier.   

Rupture of the biliary tract is a severe disease that results in localised or diffuse chemical [[Peritonitis|peritonitis]] as bile leaks into the abdomen.  If the biliary tract is infected, the peritonitis will be septic from the outset.  If the tract is not infected at the point of rupture, the peritonitis may still become septic as the presence of bile in the peritoneal cavity reduces the integrity of the gut mucosal barrier.   

Biliary tract ruptures may occur:

Biliary tract ruptures may occur:

*Secondary to [[Biliary Tract - Obstruction|'''obstruction]] of the biliary tract'''.

*Secondary to [[Biliary Tract Obstruction|'''obstruction]] of the biliary tract'''.

*After '''blunt abdominal trauma''', with the common bile duct rupturing more frequently than the gall bladder.

*After '''blunt abdominal trauma''', with the common bile duct rupturing more frequently than the gall bladder.

*If the tract is eroded by a '''neoplasm'''.

*If the tract is eroded by a '''neoplasm'''.

*Secondary to severe inflammatory disease of the gall bladder, including '''cholelithiasis''' and '''ascending cholecystitis'''<ref>Brömel C, Léveillé R, Scrivani PV, Smeak DD, Podell M, Wagner SO. '''Gallbladder perforation associated with cholelithiasis and cholecystitis in a dog''' ''J Small Anim Pract. 1998 Nov;39(11):541-4.''</ref>.

*Secondary to severe inflammatory disease of the gall bladder, including '''cholelithiasis''' and '''ascending [[Cholecystitis|cholecystitis]]'''<ref>Brömel C, Léveillé R, Scrivani PV, Smeak DD, Podell M, Wagner SO. '''Gallbladder perforation associated with cholelithiasis and cholecystitis in a dog''' ''J Small Anim Pract. 1998 Nov;39(11):541-4.''</ref>.

*After '''gall bladder torsion'''<ref>Corfield GS, Read RA, Nicholls PK, Lester N. '''Gall bladder torsion and rupture in a dog.''' ''Aust Vet J. 2007 Jun;85(6):226-31.''</ref>.

*After '''gall bladder torsion'''<ref>Corfield GS, Read RA, Nicholls PK, Lester N. '''Gall bladder torsion and rupture in a dog.''' ''Aust Vet J. 2007 Jun;85(6):226-31.''</ref>.

==Diagnosis==

==Diagnosis==

It is important that biliary tract rupture are diagnosed promptly as the peritonitis becomes more severe with time.

It is important that biliary tract rupture is diagnosed promptly as the peritonitis becomes more severe with time.

===Clinical Signs===

===Clinical Signs===

The affected animal may show few clinical signs initially besides [[Icterus|icterus]] and evidence of an [[Exudate|ascites]].  As chemical peritonitis develops, the animal may show signs of:

The affected animal may show few clinical signs initially besides [[Icterus|icterus]] and evidence of an [[Exudate|ascites]].  As chemical peritonitis develops, the animal may show signs of:

*'''Pyrexia''', anorexia and depression

*'''Pyrexia''', anorexia and depression

*'''Shock''' and collapse   

*'''Shock''' and collapse   

In cases of septic peritonitis, the animal may suffer from septic or endotoxic [[Shock - Pathology|shock]].

In cases of septic peritonitis, the animal may suffer from septic or endotoxic [[Shock|shock]].

===Laboratory Tests===

===Laboratory Tests===

Analysis of blood samples may show evidence of an acute inflammatory response, with a neutrophilic '''leucocytosis''' and elevated fibrinogen.  The neutrophilia may have a left shift or, in severe cases, it may have a degenerative right shift.  Cases with a very marked inflammatory response may develop a '''leukaemoid response''' with mobilisation of very large numbers of neutrophils from the bone marrow pools.

Analysis of blood samples may show evidence of an acute inflammatory response, with a neutrophilic '''leucocytosis''' and elevated fibrinogen.  The neutrophilia may have a left shift or, in severe cases, it may have a degenerative right shift.  Cases with a very marked inflammatory response may develop a '''leukaemoid response''' with mobilisation of very large numbers of neutrophils from the bone marrow pools.

Aspiration and cytological analysis of fluid from the abdomen will reveal it to be a form of [[Exudate|exudate]] with an evident green colouration.  The fluid may contain mucinous or fibrillar material and it should be expected to have a bilirubin concentration at least twice that of serum<ref>Owens SD, Gossett R, McElhaney MR, Christopher MM, Shelly SM. '''Three cases of canine bile peritonitis with mucinous material in abdominal fluid as the prominent cytologic finding.''' ''Vet Clin Pathol. 2003;32(3):114-20.''</ref>.

'''Aspiration and cytological analysis''' of fluid from the abdomen will reveal it to be a form of [[Exudate|exudate]] with an evident green colouration.  The fluid may contain mucinous or fibrillar material and it should be expected to have a bilirubin concentration at least twice that of serum<ref>Owens SD, Gossett R, McElhaney MR, Christopher MM, Shelly SM. '''Three cases of canine bile peritonitis with mucinous material in abdominal fluid as the prominent cytologic finding.''' ''Vet Clin Pathol. 2003;32(3):114-20.''</ref>.

===Diagnostic Imaging===

===Diagnostic Imaging===

==Treatment==

==Treatment==

Where possible, urgent surgical intervention is indicated to repair the site of the rupture.  Biliary re-routing procedures (such as cholecystojejunostomy) may be indicated in cases where the biliary tract is severely disrupted.  The bile peritonitis should be managed aggressively, as described [[Peritonitis - Cats and Dogs|here]].

Where possible, urgent surgical intervention is indicated to repair the site of the rupture.  Biliary re-routing procedures (such as cholecystojejunostomy) may be indicated in cases where the biliary tract is severely disrupted.  The [[Peritonitis - Cats and Dogs#Treatment|bile peritonitis should be managed aggressively]].

==Prognosis==

==Prognosis==

The prognosis depends on the speed with which the condition is diagnosed and on whether the peritonitis is septic.  In one study of cats and dogs, a mortality rate of 54% was reported and this represented those animals that had septic peritonitis<ref>Ludwig LL, McLoughlin MA, Graves TK, Crisp MS. '''Surgical treatment of bile peritonitis in 24 dogs and 2 cats: a retrospective study (1987-1994).''' ''Vet Surg. 1997 Mar-Apr;26(2):90-8.''</ref>.

The prognosis depends on the speed with which the condition is diagnosed and on whether the peritonitis is septic.  In one study of cats and dogs, a mortality rate of 54% was reported and this represented those animals that had septic peritonitis<ref>Ludwig LL, McLoughlin MA, Graves TK, Crisp MS. '''Surgical treatment of bile peritonitis in 24 dogs and 2 cats: a retrospective study (1987-1994).''' ''Vet Surg. 1997 Mar-Apr;26(2):90-8.''</ref>.

==References==

==References==

<references/>

<references/>

Ettinger, S.J, Feldman, E.C. (2005) '''Textbook of Veterinary Internal Medicine (6th edition, volume 2)''' ''Elsevier Saunders''

Ettinger, S.J, Feldman, E.C. (2005) '''Textbook of Veterinary Internal Medicine (6th edition, volume 2)''' ''Elsevier Saunders''

[[Category:Gall_Bladder_and_Tract_-_Pathology]]

[[Category:Gall_Bladder_and_Tract_-_Pathology]]

[[Category:To_Do_-_James]]

[[Category:Gall Bladder and Tract Diseases - Cat]][[Category:Gall Bladder and Tract Diseases - Dog]][[Category:Biliary Diseases - Cattle]][[Category:Biliary Diseases - Pig]]

[[Category:Cat]][[Category:Dog]][[Category:Horse]][[Category:Cattle]][[Category:Pig]]

[[Category:Expert_Review - Small Animal]]

[[Category:To_Do_-_Review]]

[[Category:Liver Diseases - Horse]]