Gallbladder Rupture in Dogs

Bile made by the liver is delivered to the gallbladder through bile ducts. This bile is a yellow fluid that contains chemicals to help the body digest fats. Once in the gallbladder, water is removed, which makes the bile more concentrated and potent. Normally, the bile then travels to the pancreas, and then to the small intestine where it goes to work aiding in digestion.

The presence of excessive mucus can block the ducts that are meant to lead the bile out of the gallbladder, and force it to accumulate with the mucus. This can lead to a bile duct obstruction, and an inflamed gallbladder wall that will in turn, lead to a rupture. By the time a gallbladder mucocele is diagnosed, up to 50% of pets experience a rupture. Early intervention can greatly reduce this risk.

If the mucus-producing cells inside the gallbladder produce too much mucus, it can result in a mucocele. This is a thickened and gelatinous mixture of mucus and bile that cannot be expelled from the gallbladder. As it accumulates within this organ, the gallbladder becomes distended, and may eventually rupture. If this occurs, bile will then leak into the abdominal cavity and can cause a severe and life-threatening condition.

Since a gallbladder mucocele precedes a rupture, the signs of both are often present in this serious condition. Signs can be vague, and a mucocele can remain completely undetected until a rupture occurs. Symptoms can include:

• Decrease or loss of appetite
• Vomiting
• Diarrhea
• Lethargy
• Jaundice
• Abdominal pain
• Abdominal swelling
• Fever 
• Increased breathing rate
• Increased heart rate

The cause of a gallbladder rupture is an excessive amount of mucus secretion, which then accumulates in the gallbladder as a mucocele. Reasons why this may occur include:

• Cushing’s disease 
• Hypothyroidism
• Inflammatory bowel disease
• Dyslipidemia, or hyperlipidemia
• Gallbladder dysmotility
• Gallbladder dyskinesia
• Genetic predispositions, possibly in the ABCB4 gene

A gallbladder mucocele, and the eventual rupture, generally occurs in small to medium dogs. Breeds commonly affected that may be predisposed to the condition include:

• Shetland Sheepdogs 
• Cocker Spaniels 
• Miniature Schnauzers

A diagnosis of a gallbladder mucocele and a rupture is made through a physical examination, and the results of testing. If a rupture has occurred, your dog’s abdominal cavity will likely be swelled from fluid accumulation. Palpation of the cavity should elicit a vocal cry or other signs of pain. Results from blood work can reveal an elevation of liver enzymes and white blood cells, common findings when the gallbladder has ruptured.

Ultrasounds taken of the abdominal cavity can reveal an enlarged gallbladder, and the presence of immobile echogenic bile, or the mucocele, within the gallbladder that appears in the shape of a kiwi fruit. A rupture can be further diagnosed through the presence of fluid in the abdominal cavity. This may also be seen through an X-ray.

Occasionally, surgery may be needed to confirm the diagnosis by collecting fluid and bile for testing. This can include an abdominocentesis or a gallbladder centesis. A pancreas-specific lipase test can reveal if the pancreas is also affected.

A gallbladder rupture is considered an emergency, as there is a risk of septic bile peritonitis in 40% to 60% of cases. The only treatment for a ruptured gallbladder is a cholecystectomy, or the surgical removal of the gallbladder. This procedure is also recommended for dogs who show signs of a gallbladder mucocele, as 80% of these cases show evidence of rupture or necrosis. The surgery involves removing the gallbladder and allowing the bile to flow directly from the liver to the small intestine. While the body can survive and continue normally without the gallbladder, the surgery itself carries a high level of risk. These risks include bleeding and bile leakage into the abdominal cavity, pulmonary thromboembolism, pancreatitis, and cardiac arrest.

Intensive supportive care is given both before and after surgery, and can include fluid and electrolyte therapy, antiemetics to control vomiting, pain medication, choleretics, hepatoprotectants, and antibiotics. Hospitalization after surgery may be required for up to 7 days.

Samples of the gallbladder, and sometimes the liver, taken during surgery may be submitted for analysis to determine if there is any concurrent disease that needs to be treated.

Mortality rates after this type of surgery varies, and has been reported from 20% to 50% of patients. If your dog survives the first 2 to 3 days after surgery, then his outlook for recovery is good to excellent. Early intervention can reduce the risk of complications and death. While complications usually occur immediately following the surgery, they have been reported up to 3 weeks after. Your dog should be re-examined at 2 and 4 weeks after surgery to check on his recovery.

At home, keep your dog quiet, and avoid activities such as running, playing, jumping, or climbing stairs for at least 2 weeks. You will need to monitor the area of the incision, and ensure that your dog is not licking it. If he just can’t seem to leave it alone, an Elizabethan collar, cervical collar, or t-shirt can be used to prevent him from getting to that area. You may also need to administer medications, such as pain relievers, antibiotics, anti-inflammatories, or a stool softener. Once the gallbladder has been removed, avoid fatty foods in your dog’s diet.

Preventing a gallbladder mucocele may be difficult, as the signs of this condition are often absent or subtle. If you know your dog has a predisposing condition, such as hyperlipidemia, treatment may prevent a mucocele from forming.