Choledocholithotripsy in a mare.

The research paper details the successful surgical treatment of a horse suffering from obstructive choledocholithiasis, a condition caused by stones obstructing the bile duct. Notable symptoms included chronic weight loss, intermittent fever, and jaundice among others, and several liver function tests showcased abnormal results. Clinical improvement was seen immediately after surgery, with liver function gradually normalizing, and the horse eventually returning to normal health after a period of 28 months.

Background

• The paper focuses on a 12-year-old mare, who has been suffering from choledocholithiasis – a disease condition where gallstones develop and obstruct the bile duct.
• Choledocholithiasis leads to various health problems including chronic weight loss, sporadic fever, partial anorexia, jaundice, recurrent abdominal pain, and the presence of an abdominal mass that can be felt during rectal examination.
• The condition is severe and if left untreated, can lead to debilitating health complications. The impacted bile duct leads to poor functioning of the liver, evident in the unusual liver function tests observed in the horse.

Diagnosis

• Prior to the surgery, several tests were conducted to confirm the presence of choledocholithiasis in the mare.
• These tests included evaluation of alkaline phosphatase, bilirubin, gamma-glutamyl transferase, sorbitol dehydrogenase levels, and bromsulpthalein half-life – all of which are associated with the liver’s functionality.
• Increased values in these tests, combined with evident bilirubinuria (the presence of bilirubin in the urine) confirmed the diagnosis.
• Liver biopsies further revealed fibrosis around the bile duct, along with bile duct proliferation, blockage of flow of bile (cholestasis), and damage to the liver cells (hepatocellular necrosis).

Surgical treatment and its outcomes

• The condition was corrected by choledocholithotripsy, a surgical procedure that involves the crushing of gallstones blocking the bile duct.
• Immediately after surgery, the mare showed signs of clinical improvement. Liver function tests conducted after surgery showed a return to normal values over time.
• Furthermore, the horse returned to its usual weight after the surgery. Over the course of 28 months post-surgery, the mare remained free of liver disease, and went on to serve as a broodmare, indicating a return to normal health.