CLINICAL CORRELATIONS OF THE BILIOPANCREATIC

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Cercetãri Experimentale & Medico-Chirurgicale
Anul XIII l Nr.2/2006 l Pag. 85-91
Cercetari
e x p e r i m e n ta le &
m edico-chirurgicale
CLINICAL CORRELATIONS OF THE
BILIOPANCREATIC CARREFOUR IN DOGS AND CATS
Gheorghe M. Constantinescu1, Summary: Complete understanding of the biliopancreatic carrefour (BPC) in dogs and cats
is crucial for successful surgical management of hepatobiliary disease and diseases
Fred Anthony Mann2,
requiring upper gastrointestinal resection.
1
Ileana A. Constantinescu
Received for publication: 11.12.2005
Revised: 31.02.2006
In the dog the choledochus differs in shape and relationship to the pancreatic duct compared
to the same structure of the cat. The openings of the ducts in the major duodenal papilla also
differ between the dog and the cat. In the cat a hepatopancreatic ampulla (HPA) similar to
that in humans protects the openings of both ducts. The ducts are provided with sphincters;
an additional sphincter of the HPA is present in the cat. The clinical relevance of the close
proximity of the choledochus and pancreatic duct in both dogs and cats is manifest as biliary
obstruction secondary to swelling or scarring as a result of pancreatitis. The hepatic artery,
portal vein and bile duct are together enclosed in a peritoneal fold of the hepatoduodenal
ligament forming the ventral rim of the omental foramen. Surgeons exploit this knowledge of
anatomy by performing the Pringle maneuver to control hepatic hemorrhage. In dorsal
recumbency the BPC is approached surgically from the right side using the mesoduodenum
as an anatomical retractor to reflect the abdominal viscera to the left. Common surgical
interventions requiring complete knowledge of the BPC include cholecystoduodenostomy,
partial gastrectomy with upper duodenal resection (Bilroth II procedure), cholecystectomy,
cholecystotomy, and partial pancreatectomy.
A perfect knowledge of the anatomy of the BPC is also needed for accurate diagnostic
investigations using endoscopy, ultrasonography, computed tomography, and magnetic
resonance imaging.
Keywords: type 1 diabetes mellitus, pancreatic autoantibodies, prediction
1 - Biomedical Sciences, College of Veterinary Medicine, University of Missouri-Columbia
2 - Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri-Columbia
Introduction
n
An increasing incidence of hepatobiliary
abnormalities in dogs and cats and need for precise
diagnosis procedures is recently mentioned in the
literature (Fahie, Martin,1995; Leveille, Biller,
Shiroma, 1996; Newell et al, 1996; Barnhart,
Rasmussen, 1996; Ludwig, 1997; Rivers et al,
1997; Bromel et al, 1998; Voros et al, 2001; Eich,
Ludwig et al, 2002; Mayhew et al, 2002; Owens et
al, 2003; Bacon, White, 2003; Savary-Bataille et al,
2003; Holt et al, 2004; Worley, Hottinger,
Lawrence, 2004; Mehler et al, 2004 etc. etc.).
Correspondence to:
n
Unfamiliarity with the anatomy of the biliary
system and surrounding structures will hamper
confidence in surgical manipulations necessary to
treat some of these abnormalities.
Gheorghe M. Constantinescu , College of Veterinary Medicine, University of Missouri,
1600 E. Rollins, Columbia, Missouri, 65211, USA
85
86
ANATOMICAL DIFFERENCES BETWEEN THE DOG AND THE CAT
n
In the dog the choledochus differs in shape and
relationship to the pancreatic duct compared to the
same structure of the cat. The openings of the
ducts in the major duodenal papilla provided with
sphincters also differ between the dog and the cat.
In the cat a hepatopancreatic ampulla (HPA) similar
to that in humans protects the openings of both
n
n
ducts. An additional sphincter of the HPA is present
in the cat.
The sphincter of Oddi in the dog is illustrated in
detail.
The distribution of the hepatic branches of vagus N.
in the dog follows (Stanley L. Chiu, 1943).
87
muscular septum into two compartments, one for
the bile duct and one for the pancreatic duct. The
submucosal part of ductus choledochus is mainly
formed by the major duodenal papilla. This is
provided with a sphincter (sphincter of Oddi). The
sphincter of Oddi is composed of various layers of
smooth muscle embedded in connective tissue
with complex relations to other muscular
structures of the choledocho-duodenal junction.
Crucial need for strong knowledge of biliary
anatomy in the area of:
n
n
ANATOMICAL DIFFERENCES BETWEEN THE
DOG AND THE CAT
n
n
88
According to Kyosola and Rechardt (1974), in the
cat the HPA gives rise to concentric retrograde
saccules around the ampulla and the terminal part
of the bile duct. The Fenestra choledocha, the
slit-like opening in the circular muscle layer of the
duodenum pierces the rigth side posterior wall of
the duodenum.
Boyden in 1957 divided the intramural part of
choledochus into a proximal infundibular part and a
distal submucosal part. The infundibular part is
enclosed in a muscular funnel divided by a
n
Diagnostic imaging
o Abdominal ultrasonography
o Biliary scintigraphy
Treatment of various conditions
o Cholangitis,
necrotizing
cholecystitis,
cholelithiasis, biliary mucoceles, biliary
obstruction
Successful surgical and endoscopic procedures
o Cholecystoenterostomy,
cholecystectomy,
laparoscopic biliary procedures
o Upper gastrointestinal resections
Making the correct intra-operative decision
Bile leaking into the abdominal cavity:
Cholecystoenterostomy vs. Cholecystectomy ?
Gall bladder rupture:
n Bile duct obstruction?
o Cholecystoenterostomy is indicated.
n Necrotizing cholecystitis?
o Cholecystectomy is indicated.
The wrong choice would likely be fatal
n
Clinical relevance
n
The clinical relevance of the close proximity of the
choledochus and pancreatic duct in both dogs and
cats is manifest as biliary obstruction secondary to
swelling or scarring as a result of pancreatitis.
Clinical correlates
n
In dorsal recumbency the BPC is approached
surgically from the right side using the
mesoduodenum as an anatomical retractor to
reflect the abdominal viscera to the left.
n
Surgeons exploit the knowledge of anatomy by
performing the Pringle maneuver to control hepatic
hemorrhage.
Common surgical interventions requiring complete
knowledge of the BPC include cholecystoduodenostomy, partial gastrectomy with upper
duodenal resection (Bilroth II procedure),
cholecystectomy, cholecystotomy, and partial
pancreatectomy.
Mesoduodenum
Cranial
Mesocolon
89
Hepatic artery
Vena cava
Cranial
Conclusions
A complete understanding and perfect knowledge of
the anatomy of the BPC in dogs and cats is crucial for
precise diagnosis and successful surgical interventions:
n for accurate diagnostic investigations using
endoscopy, echoendoscopy, ultrasonography,
computed tomography, scintigraphy, and
magnetic resonance imaging
n for performing successful surgical interventions in
conditions such as hepatobiliary disease and
various pancreatic ducts conditions
90
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