Post-Hepatic Obstruction By A Duodenal Papilla Calculus In A 9-Year-Old FS DSH Cat: Sonopath Case Of the Month July 2019

High-end views are extremely important for all patients to provide an accurate diagnosis. SonoPath Mobile’s own Shari Reffi, CVT, SDEP™ certified clinical sonographer expertly dialed into this cat’s biliary tree and located the reason for an ALT of over a thousand! A rock! No, not “The Rock”, but a duodenal papilla calculus.

History
History of a sewing needle stuck in the caudal aspect of hard palate a month prior. 24 inches of string was attached and removed (without resistance) under sedation. The patient then presented almost one month later for anorexia, vomiting and hiding. Blood chemistry found ALT >1000, glucose 223, T. Bili. 2.3, TP 9.4, Glob. 6.1. No significant findings on radiographs.

Image Interpretation
The liver in this patient presented an over distended gallbladder. The common bile duct was dilated at 5.0 mm. Lobar biliary duct dilation was noted as well. Regional inflammation was noted around the common bile duct. The common bile duct was followed to the duodenal papilla. A 3.0 mm calculus was embedded within the duodenal papilla, obstructing the common bile duct. The pancreatic duct was dilated in this patient.

DX
Chronic triad disaease with post-hepatic obstruction by a duodenal papilla calculus. Concurrent regional pancreatic inflammation, cholangitis pattern, IBD presentation.
Outcome
Surgical intervention with liberation of the common bile duct and appropriate biopsies is indicated.