Gall Bladder Mucocele

We've seen a couple of cases recently of gall bladders gone bad. To be more precise, they have been filled with a gelatinous mass of gunk. Usually the gall bladder contains bile, a greenish-black fluid. After a meal, the bile is released into the intestines to aid digestion. In some animals, for reasons that aren't exactly clear, the bile stays in the gall bladder and gradually gets thicker and thicker. Eventually, bile cannot flow out properly and begins to 'back up' into the liver where it is toxic to the liver. Usually the wall of the gall bladder is also abnormal. The condition is called either gall bladder mucocele or cystic mucinous hyperplasia. Ultrasound is the primary way the condition is diagnosed. In a normal patient, the bile appears black within the gall bladder. As you can see below in a patient with a mucocele, the gall bladder is filled with white or light gray strands, and the contents of the gall bladder are very organized and immobile.


The above ultrasound picture is from a little dog had a long history of elevated liver enzymes, but minimal symptoms. Over the weekend she stopped eating, felt bad, and had some vomiting. Her veterinarian sent her to TVEC for an ultrasound and within the hour she was diagnosed with a gall bladder mucocele. The gall bladder had ruptured, spilling toxic bile into the abdomen. That night she had surgery and the remnants of the ruptured gall bladder and it's hardened contents were removed. Fortunantely for her, she made a full recovery and is doing well at home! This isn't true for all patients; if not treated immediately, gall bladder rupture can be fatal.

There is some controversy about this condition in patient's who aren't sick. Like the above example, many pets can have this condition for a while without any symptoms. If you happen to find this condition when you perform an ultrasound for other reasons, do you remove the gall bladder in a patient who isn't sick? This isn't a minor procedure, and there are risks from the surgery. But leaving it alone isn't a simple decision either, because many patients can be asymptomatic for a long time before they suddenly get sick and die a short time later. It really is a ticking time bomb, and you don't know whether it is safer to try and defuse it, or whether it is safer to leave it alone. Some veterinarians feel strongly one way or another, but it really is a case by case decision. When the patient is sick, or there is the suspicion of a gall bladder rupture, everyone agrees you have to go to surgery. Fortunately, many dogs do very well with surgery and make a complete recovery.