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

Objectives: 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.

Materials and methods: 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.

Results: 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.

Clinical significance: 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.