In cats, EHBTO may develop as a result of biliary neoplasia, pancreatic neoplasia, chronic pancreatitis, parasitic biliary infestation, or cholelithiasis.1–7 Because EHBTO is uncommon in cats, guidelines for the medical and surgical management of affected cats have not been fully established. Nevertheless, it is clear that in cats with EHBTO in which biliary tract patency cannot be reestablished, some form of biliary diversion procedure must be performed to allow decompression of the biliary tree.
Surgical methods for biliary diversion include cholecystoduodenostomy and cholecystojejunostomy, but these procedures have been associated with high perioperative morbidity and mortality rates and short overall survival times in cats.1,4,7 In a recent study,4 for instance, perioperative complications, including refractory hypotension and hemorrhage, occurred in 80% of cats, and this high complication rate likely accounts for the fact that only 40% to 60% of cats described in previous reports1,4,7 survived long enough to be discharged from the hospital following biliary diversion surgery.
Causes for the high perioperative morbidity and mortality rates in cats undergoing biliary diversion surgery have not yet been identified. However, in previous reports1,3,8–12 involving 27 dogs that underwent biliary diversion surgery, 10 died within 6 weeks after surgery. Similarly, morbidity and mortality rates for human patients undergoing surgery for obstructive jaundice are reportedly high.13–15 The principal risk factors for death in human patients with obstructive jaundice undergoing surgery include a malignant cause for biliary obstruction, PCV < 30%, hypoalbuminemia, serum bilirubin concentration > 11 mg/dL, azotemia, and the presence of acute cholangitis.13–15 In patients with only 1 of these risk factors, the mortality rate is 9%, but in patients with ≥ 3 risk factors, it is 60%.13,14
Factors associated with a poor clinical outcome in cats with EHBTO undergoing biliary diversion surgery have not been well characterized. The purpose of the study reported here, therefore, was to identify factors associated with outcome in cats with EHBTO that undergo cholecystoenterostomy.
Extrahepatic biliary tract obstruction
Systat, version 10.0, SPSS Inc, Chicago, Ill.
Hetastarch, Abbott Laboratories, North Chicago, Ill.
Oxyglobin, Biopure, Cambridge, Mass.
Prescription Diet Feline i/d, Hill's Pet Nutrition Inc, Topeka, Kan.
Viokase-V, Fort Dodge Animal Health, Fort Dodge, Iowa.
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