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The placement of a plastic or metal stent (tube) in your cat's bile duct is a procedure your veterinarian may use when obstruction of the bile duct is present to open up the duct and allow the passage of bile. It is also referred to as choloedochal stenting. A stent is a tube surgically placed in a duct to ensure the duct is open and functioning and allows necessary substances to pass normally. In your cat's gallbladder, bile produced in the liver passes through the bile duct into the gallbladder where it is stored and then released to digest fats in the intestine. When obstruction of the bile duct occurs such as from gallstones, or a buildup of thick bile causing inflammation, a dangerous condition develops characterized by inflammation of the gallbladder, and if not treated rupture and death can result.
Surgical procedures such as cholecystectomy to remove the gallbladder or choledochotomy to surgically remove gallstones are options to treat blockages in your cat's bile duct. Choloedochal stenting is sometime used in conjunction with choledochotomy or as an alternative procedure. It is not commonly used in veterinary medicine as it a difficult procedure to perform in small animals such as cats. A choloedenchal stent may be placed through traditional, open surgical techniques or through endoscopic techniques, which involve a tube with a camera being placed through the esophagus into the gastrointestinal system. The stent may be temporary, and passes through the gastrointestinal system, or removed at a later date, or it may be permanently placed to keep the bile duct open on an ongoing basis. A veterinary surgeon with experience in this procedure is required as it is a complicated procedure. If surgery is performed endoscopically, a human gastroenterologist or veterinary specialist may be required to be present to provide guidance.
Your veterinarian will provide you with instruction on pre-surgery care. Detailed radiographs may be taken; x-ay and/or ultrasound to guide your veterinary surgeon on the location of organs and blockages.
The night prior to surgery you will need to fast your cat from food and water.
When you arrive at the veterinarian your cat’s temperature will be taken rectally to ensure infection is not present.
Your cat will be given a sedative to calm them, followed by intravenous anesthetic to immobilize your cat and put them into a deep sleep. If anesthetic is going to be maintained by gas, a breathing tube will be inserted into your cat's throat, and anesthesia maintained by gas for the duration of the procedure.
Stenting may be placed endoscopically which means your veterinarian will insert a tube with a small camera through the esophagus into the gastrointestinal system to guide the procedure. A wire will be inserted through the bile duct experiencing stricture or obstruction and a stent will be passed over the wire into place in the bile duct.
Your veterinrairn may also perform cholodochal stenting through the abdomen via an incision. Your cat's abdomen will be shaved and cleaned and an incision made. Tissues will be moved aside and the bile duct will be isolated. Stents may be placed in conjunction with choledochotomy surgery, after blockages of the bile duct are removed through an incision in the bile duct. After removal of obstructions, the bile duct will be repaired, and a stent placed to allow the duct to drain internally. Stents may move through the gastrointestinal system and be passed through stool or may be removed at a later date if necessary.
Your cat will require hospitalization to receive postoperative care and careful veterinary observation to ensure complications do not occur.
Bile duct stent placement is not a common procedure in cats as surgical placement in small animals is complicated and is associated with a high morbidity rate in cats. If placement of the stent is successful it can be an effective way to relieve bile duct obstruction or stricture without needing to remove the gallbladder or associated structures. Stents may, however, become blocked or fail to relieve blockage or narrowing.
Your cat will require rest and careful monitoring. Recovery will require a few weeks and activity should be restricted during this time. As conditions associated with this procedure are very serious, recovery from stenting placement is associated primarily with recovery of the condition that necessitated bile duct stenting. Treatment of pancreatic disorder or other associated conditions will be directed by your veterinarian. Postoperative vomiting has been reported in some cats and you will need to monitor your cat to ensure this does not become excessive and require addressing by your veterinarian. Your cat may be prescribed a low fat diet to ease stress on the gastrointestinal system. Your cat's food and water intake and output and energy level should be monitored and feedback provided to your veterinarian. Follow up with your veterinarian postoperatively will be scheduled to ensure recovery.
Cost of bile duct stenting will vary with the cost of treatment of the condition associated with bile duct obstruction. The procedure itself, including radiography, tests, anesthetic, procedure and hospitalization range from $750 to $2,000 and may not include additional treatment and medication for the precipitating condition.
There is a high risk with this procedure, especially in cats, because associated structures are small and the procedure is difficult.
If endoscopy is conducted the wire may tear gastrointestinal structures. Stents may become blocked, especially if the condition associated such as a tumor, thickened bile or gallstones are not addressed. The stent or procedure to place the stent may cause inflammation of the bile duct or other organs. Leaks from the bile duct or other compromised tissues in the abdomen can cause life-threatening infection. Stenting may not address the narrowing of the duct causing rupture of the duct or gallbladder if obstruction persists. High morbidity is associated with this procedure in cats and should be discussed with your veterinarian prior to surgery. An experienced veterinary surgeon or the presence of consultation by a human gastroenterologist with experience in this procedure mitigates some of the risks.
Preventing accidents in your home and providing outdoor activity in a controlled environment will reduce the likelihood of injury and damage to the gallbladder from trauma. A healthy balanced diet, low in fat, and appropriate exercise to maintain weight will help in maintaining a healthy digestive system and reduce the likelihood of your cat experiencing bile duct blockages and other medical conditions that would necessitate stent placement in the bile duct. Monitor your cat and provide regular veterinary care to address symptoms and medical conditions at an early stage, which will reduce the likelihood of gastrointestinal disorders becoming advanced and causing issues requiring stent placement.
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