Clinicopathological features of feline emphysematous cholecystitis: five cases (2017-2022)

Emphysematous cholecystitis is a rare manifestation commonly associated with acute cholecystitis complicated by gas-producing organisms. The study aimed to describe the clinical and pathological features of emphysematous cholecystitis in cats.

The databases of 32 Diplomate-led Small Animal Internal Medicine referral centres located in the United Kingdom and Ireland were searched. Five cases with confirmed feline emphysematous cholecystitis were identified and retrospectively reviewed.

The main clinical signs included inappetence (100%), vomiting (80%) and lethargy (60%). The main abnormalities on physical examination were jaundice (60%), abdominal discomfort (40%) and organomegaly (40%). The most common laboratory abnormalities were leucocytosis (range 1.12- to 2.3-fold increase), lymphopenia (range 0.4- to 0.93-fold decrease), increased serum alanine transaminase activity (range 2.02- to 11.72-fold increase) and hyperbilirubinemia (range 4.8- to 18.58-fold increase). Abdominal imaging including ultrasound or computed tomography showed dilated intra- and extra-hepatic bile ducts and luminal and/or intra-luminal gas foci in all cases. Bacterial culture identified a moderate growth of Corynebacterium spp. in one case and Enterococcus spp. in another case. Three cats survived to discharge following cholecystectomy; two of which had medical stabilisation prior to surgery. Two cats died; one was treated medically and the other treated surgically without prior medical stabilisation.

This is the first time that emphysematous cholecystitis has been described in a cohort of cats. It warrants consideration as a rare differential diagnosis in cats presenting with increased serum alanine transaminase activity and bilirubin. Medical stabilisation with antibiotic therapy followed by cholecystectomy may offer a favourable outcome.