Clinical features, diagnostic findings, and outcomes of emphysematous cholecystitis in 35 dogs: a retrospective case series

Abstract Background Emphysematous cholecystitis (EC) is a rare and severe variant of acute cholecystitis in dogs. Published data regarding EC are limited. Hypothesis/Objectives To retrospectively describe the clinical presentation, relevant laboratory values, ultrasonographic findings, bile cytology, bacterial culture and susceptibility results, gallbladder histopathology, treatment, and outcomes in a group of dogs diagnosed with EC. Animals Thirty-five client-owned dogs diagnosed with EC. Methods A retrospective review of medical records from 4 referral veterinary teaching hospitals between January 2000 and December 2024 was conducted to describe dogs diagnosed with EC via ultrasonography or computed tomography. Results Common clinical signs reported included vomiting (23/35, 66%), lethargy (23/35, 66%), or inappetence (15/35, 43%) in dogs. Common clinicopathologic abnormalities were an inflammatory leukogram (21/31, 68%) and elevated serum liver enzyme activity with or without hyperbilirubinemia (28/33, 85%). The most frequent bacteria isolated were Escherichia coli (13/36 isolates) and Clostridium spp. (12/36 isolates). Postoperative death among dogs that underwent cholecystectomy was 29% (4/14). Eleven of 35 (31%) dogs were treated medically and survived to discharge and 5 of 6 dogs with long-term follow-up survived > 6 months. Conclusions and clinical importance Dogs with EC often present as clinically ill with an inflammatory leukogram, elevated serum liver enzyme activity, and mild hyperbilirubinemia. Cholecystectomy permits source control and collection of gallbladder culture to guide antimicrobial therapy, but empirical medical management can be successful.