When should you do cholecystocentesis?

Association between Gallbladder Ultrasound Findings and Bacterial Culture of Bile in 70 Cats and 202 Dogs

R Policelli Smith 1, J L Gookin 1, W Smolski 1, M F Di Cicco 1, M Correa 1, G S Seiler 1

Background
Bacterial cholangitis is a recognized cause of hepatobiliary disease in cats and dogs, often diagnosed using gallbladder ultrasound (US) and bile culture. The predictive value of gallbladder US findings in identifying bile bacterial infection remains unclear. This study aimed to evaluate the association between gallbladder US abnormalities and positive bile culture results, determine the most common bacterial isolates, and assess complication rates of cholecystocentesis in dogs and cats with suspected hepatobiliary disease.

Methods
A retrospective cross-sectional study was conducted on 272 patients (70 cats, 202 dogs) from North Carolina State University (2003–2013) who underwent gallbladder US and bile culture.

Gallbladder abnormalities assessed:
-Thickened gallbladder wall
-Gallbladder wall edema
-Mucosal hyperplasia
-Sludge or choleliths
-Mucocele formation

Statistical analysis: Sensitivity, specificity, and predictive values of US findings for positive bile culture were calculated.

Complication rate of percutaneous ultrasound-guided cholecystocentesis (PUC) was evaluated.

Results
Bacterial Culture Findings:
-Cats: 33% (23/70) had positive bile cultures.
-Dogs: 18% (36/202) had positive bile cultures.
-Most common isolates: Escherichia coli (49%) and Enterococcus spp. (38%).
-Mixed infections were found in 25% of cases, most commonly E. coli + Enterococcus spp..

Ultrasound Findings & Predictive Value for Bacterial Infection:
Cats:
-96% sensitivity, 49% specificity, 48% positive predictive value (PPV), 96% negative predictive value (NPV).
-Most predictive signs: Gallbladder wall thickening and sludge (cats with these findings were 21× more likely to have a positive bile culture)
.
Dogs:
-81% sensitivity, 31% specificity, 20% PPV, 88% NPV.
-No single US abnormality reliably predicted bacterial infection in dogs.

Complication Rate of Cholecystocentesis:
-3.4% of dogs and 2.8% of cats had minor complications (e.g., mild peritoneal hemorrhage, gallbladder edema, transient intraluminal hemorrhage).
-No life-threatening complications occurred.

Limitations
This was a retrospective study, and bile cultures were performed based on clinical suspicion rather than standardized criteria, possibly affecting prevalence rates. Antibiotic history was not evaluated, which may have influenced culture results. The study did not correlate bacterial culture results with clinical outcomes or treatment responses.

Conclusions
Gallbladder US has a high negative predictive value (96%) in cats, meaning normal US findings strongly suggest an absence of bacterial infection. However, abnormal US findings are poorly specific, as many cats with gallbladder changes had negative bile cultures. In dogs, gallbladder US was less predictive of bacterial infection, suggesting bile culture should be performed regardless of US findings. Percutaneous cholecystocentesis is a safe procedure with a low complication rate.

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