Choledochoduodenostomy in Cats

Choledochoduodenostomy is a surgical procedure that belongs to a group of procedures with the primary goal of bile flow diversion. Choledochoduodenostomy is primarily reserved for benign obstructions of the bile duct. Choledochouoenostomy may be performed in conjunction with removal of the gallbladder to allow bile to flow directly to the small intestine. In this surgical procedure, the common bile duct will be diverted to conjoin with the duodenum. This surgical repositioning of the bile duct will allow bile to flow directly into the intestine. 

Bile is the fluid the body uses to break down fats that the feline consumes during a meal. Usually, bile flows from the liver, into the gallbladder and into the small intestine through a bile duct. However, an obstruction of the bile duct will prevent bile from reaching the small intestine. The procedure is not commonly performed in cats, but a  veterinary surgeon may perform a choledochoduodenostomy in a cat if he/she has a tumor, trauma or other condition affecting the flow of bile. 

Choledochoduodenostomy is carried out under general anesthesia. The veterinarian will perform pre-operative blood work to ensure the patient is in good health to have anesthetic administered and for the surgery itself. The cat will then be given a pre-surgical sedative, followed by a tracheal tube to allow the flow of oxygen and anesthetic gas. Once sedated, he will be taken to the surgical area where the belly will be shaved and cleansed with a sterile antiseptic. The veterinarian will then proceed to perform the surgery. If the gallbladder is to be removed, that will be done prior to the anastomosis of the common bile duct and the duodenum, as described below. 

1. The gallbladder will be mobilized from the liver using blunt dissection. 
2. The gallbladder organ is removed. 
3. The bile duct will be brought to the descending duodenum (portion of the intestine). 
4. The surrounding area will be packed with sterile, moistened laparotomy sponges. (A type of sponge used to keep internal organs from drying out). 
5. A continuous suture of absorbable nature will be placed between the serosa of the duct and the serosa of the duodenum. 
6. The gallbladder duct will be drained prior to creating an incision.
7. An incision will be made in the surface of the duodenum. 
8. The two openings will be brought together and permanently conjoined using an absorbable suture material. 

The goal the veterinarian wishes to obtain from a choledochoduodenostomy procedure is to allow the patient to receive bile fluids into the intestine despite the fact that the gallbladder is non-functional. If the surgery is successful, bile fluids will be allowed to flow directly from the liver through the bile duct and directly to the large intestine. The bile will be released in response to the ingestion of a meal as usual and the yellow chemical filled fluid will restore the cat’s ability to break down fats. 

Following a choledochoduodenostomy surgery, your cat will require a great deal of at-home care. Pain and antibacterial medications will need to be administered every day to ensure a positive recovery. Your veterinarian will limit the cat’s physical activities and recommend a change in diet for a selective period of time. 

Choledochoduodenostomy in cogs will cost a pet owner $800 to $3,000. Antibiotics will add another $10-$30 to your total cost and if biopsies are required, an additional $160 or more. 

Cats that require a choledochoduodenostomy procedure are usually very ill, which puts them at a high risk for post-surgical death. In general, patients have a 50/50 chance of survival after surgery. However, if the cat has survived two to three days after the surgery, then the likelihood that he or she will live a long life increase greatly. Other considerations of choledochoduodenostomy surgery include jaundice, pancreatitis and liver infection. 

The need for choledochoduodenostomy procedure cannot always be prevented, but obesity has been known to be a significant factor for bile duct complications in felines. Proper diet and daily exercise are great preventative measures for maintaining a healthy bile duct system.