Full text loading...
The liver and biliary tract
/content/chapter/10.22233/9781910443248.chap9
The liver and biliary tract
- Author: Jacqui D. Niles
- From: BSAVA Manual of Canine and Feline Abdominal Surgery
- Item: Chapter 9, pp 179 - 204
- DOI: 10.22233/9781910443248.9
- Copyright: © 2015 British Small Animal Veterinary Association
- Publication Date: November 2015
Abstract
Small animal patients commonly present with conditions of the liver and biliary tract that require surgical intervention. This chapter looks at anatomy, patient evaluation, diagnosis and management. Operative techniques: Hepatic biopsy techniques and partial lobectomy; Complete hepatic lobectomy; Cholecystotomy; Cholecystectomy; Biliary diversion: cholecystoduodenostomy or cholecystojejunostomy.
Preview this chapter:
The liver and biliary tract, Page 1 of 1
< Previous page | Next page > /docserver/preview/fulltext/10.22233/9781910443248/9781910443248.9-1.gif
/content/chapter/10.22233/9781910443248.chap9
Figures
/content/figure/10.22233/9781910443248.chap9.ch9fig1
9.1
(a) Anatomy of the liver. (b) The hepatorenal ligament extending from the caudate lobe to the right kidney. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_1_thumb.gif
10.22233/9781910443248/fig9_1.png
9.1
(a) Anatomy of the liver. (b) The hepatorenal ligament extending from the caudate lobe to the right kidney. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
/content/figure/10.22233/9781910443248.chap9.ch9fig2
9.2
The epiploic foramen bounded by the hepatic artery (black arrow), portal vein (white arrow) and caudal vena cava (yellow arrow). © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_2_thumb.gif
10.22233/9781910443248/fig9_2.png
9.2
The epiploic foramen bounded by the hepatic artery (black arrow), portal vein (white arrow) and caudal vena cava (yellow arrow).
/content/figure/10.22233/9781910443248.chap9.ch9fig3
9.3
Intrahepatic portal vein anatomy. (Illustration by T Vojt, courtesy of S Birchard) © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_3_thumb.gif
10.22233/9781910443248/fig9_3.png
9.3
Intrahepatic portal vein anatomy. (Illustration by T Vojt, courtesy of S Birchard)
/content/figure/10.22233/9781910443248.chap9.ch9fig5
9.5
Removal of the falciform ligament to improve visualization of the cranial abdomen. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_5_thumb.gif
10.22233/9781910443248/fig9_5.png
9.5
Removal of the falciform ligament to improve visualization of the cranial abdomen.
/content/figure/10.22233/9781910443248.chap9.ch9fig6
9.6
Torsion of the left medial liver lobe in a 7-year-old Cocker Spaniel bitch. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_6_thumb.gif
10.22233/9781910443248/fig9_6.png
9.6
Torsion of the left medial liver lobe in a 7-year-old Cocker Spaniel bitch.
/content/figure/10.22233/9781910443248.chap9.ch9fig7
9.7
(a) Large and (b) small biliary cystadenomas in the liver of a cat. (c) Multifocal hepatocellular carcinoma. (d) Diffuse form of hepatocellular carcinoma, which is not amenable to surgical resection. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_7_thumb.gif
10.22233/9781910443248/fig9_7.png
9.7
(a) Large and (b) small biliary cystadenomas in the liver of a cat. (c) Multifocal hepatocellular carcinoma. (d) Diffuse form of hepatocellular carcinoma, which is not amenable to surgical resection.
/content/figure/10.22233/9781910443248.chap9.ch9fig8
9.8
Anatomy of the extrahepatic biliary tract. Hepatic ducts from the quadrate and right medial lobes (central division of the liver) enter the bile duct at its origin, along with the cystic duct from the gallbladder. Hepatic ducts from the right lateral and caudate lobes, left lateral and medial lobes and the papillary process of the caudate lobe enter the free portion of the bile duct more distally. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_8_thumb.gif
10.22233/9781910443248/fig9_8.png
9.8
Anatomy of the extrahepatic biliary tract. Hepatic ducts from the quadrate and right medial lobes (central division of the liver) enter the bile duct at its origin, along with the cystic duct from the gallbladder. Hepatic ducts from the right lateral and caudate lobes, left lateral and medial lobes and the papillary process of the caudate lobe enter the free portion of the bile duct more distally. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
/content/figure/10.22233/9781910443248.chap9.ch9fig9
9.9
(a) Common bile duct (arrowed) entering the dudonenum. (b) The distal portion of the bile duct in the dog is intramural. It courses obliquely through the duodenal wall and terminates alongside but separate from the pancreatic duct at the major duodenal papilla. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_9_thumb.gif
10.22233/9781910443248/fig9_9.png
9.9
(a) Common bile duct (arrowed) entering the dudonenum. (b) The distal portion of the bile duct in the dog is intramural. It courses obliquely through the duodenal wall and terminates alongside but separate from the pancreatic duct at the major duodenal papilla. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
/content/figure/10.22233/9781910443248.chap9.ch9fig11
9.11
Ultrasonogram showing a choledocholith with distension of the common bile duct proximal to it. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_11_thumb.gif
10.22233/9781910443248/fig9_11.png
9.11
Ultrasonogram showing a choledocholith with distension of the common bile duct proximal to it.
/content/figure/10.22233/9781910443248.chap9.ch9fig13
9.13
(a) Duodenotomy of the antimesenteric border of the proximal duodenum allowing visualization of the major duodenal papilla and cannulation of the common bile duct. (b) From the duodenal approach the tube may be ended within the lumen of the duodenum and held in place with absorbable sutures. This allows bile to flow into the duodenal lumen. The tube migrates into the duodenum postoperatively and passes from the body with the faeces. (c–d) Alternatively the tube can be placed through the abdominal wall on the right side, then tunnelled through the duodenum, similar to a jejunostomy tube. This has the advantage that cholangiography can be performed and the tube can be easily removed. (Photographs courtesy of S Birchard). Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_13_thumb.gif
10.22233/9781910443248/fig9_13.png
9.13
(a) Duodenotomy of the antimesenteric border of the proximal duodenum allowing visualization of the major duodenal papilla and cannulation of the common bile duct. (b) From the duodenal approach the tube may be ended within the lumen of the duodenum and held in place with absorbable sutures. This allows bile to flow into the duodenal lumen. The tube migrates into the duodenum postoperatively and passes from the body with the faeces. (c–d) Alternatively the tube can be placed through the abdominal wall on the right side, then tunnelled through the duodenum, similar to a jejunostomy tube. This has the advantage that cholangiography can be performed and the tube can be easily removed. (Photographs courtesy of S Birchard). Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
/content/figure/10.22233/9781910443248.chap9.ch9fig14
9.14
(a) Tube cholecystotomy. (b–c) The Foley catheter should be connected to a closed connecting system and the amount of bile produced should be monitored. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_14_thumb.gif
10.22233/9781910443248/fig9_14.png
9.14
(a) Tube cholecystotomy. (b–c) The Foley catheter should be connected to a closed connecting system and the amount of bile produced should be monitored. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
/content/figure/10.22233/9781910443248.chap9.ch9fig15
9.15
Choledochotomy. (a) Fine stay sutures of polypropylene should be placed to allow traction on the duct and the area should be well packed off. A small incision should be made using a No. 15 scalpel blade. (b) Markedly dilated common (black arrow) and cystic (white arrow) ducts in a cat with a choledocholith. (c) Stay sutures are placed through the wall of the common bile duct. (d) An incision is made into the duct directly over the choledocholith. (e) The choledocholith. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_15_thumb.gif
10.22233/9781910443248/fig9_15.png
9.15
Choledochotomy. (a) Fine stay sutures of polypropylene should be placed to allow traction on the duct and the area should be well packed off. A small incision should be made using a No. 15 scalpel blade. (b) Markedly dilated common (black arrow) and cystic (white arrow) ducts in a cat with a choledocholith. (c) Stay sutures are placed through the wall of the common bile duct. (d) An incision is made into the duct directly over the choledocholith. (e) The choledocholith. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
/content/figure/10.22233/9781910443248.chap9.figot9_1_1
A loop of absorbable suture material is placed around the tip of a liver lobe.
A loop of absorbable suture material is placed around the tip of a liver lobe. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_1_1_thumb.gif
10.22233/9781910443248/fig9_1_1.png
A loop of absorbable suture material is placed around the tip of a liver lobe.
A loop of absorbable suture material is placed around the tip of a liver lobe.
/content/figure/10.22233/9781910443248.chap9.figot9_1_2
The suture is tied tightly and an empty suture packet is placed below the tip of the liver to act as a ‘cutting board’. The hepatic tissue is cut approximately 5 mm from the ligature.
The suture is tied tightly and an empty suture packet is placed below the tip of the liver to act as a ‘cutting board’. The hepatic tissue is cut approximately 5 mm from the ligature. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_1_1a_thumb.gif
10.22233/9781910443248/fig9_1_1a.png
The suture is tied tightly and an empty suture packet is placed below the tip of the liver to act as a ‘cutting board’. The hepatic tissue is cut approximately 5 mm from the ligature.
The suture is tied tightly and an empty suture packet is placed below the tip of the liver to act as a ‘cutting board’. The hepatic tissue is cut approximately 5 mm from the ligature.
/content/figure/10.22233/9781910443248.chap9.figot9_1_3
The biopsy site can be packed with a small piece of Gelfoam® or omentum following removal of the hepatic tissue to facilitate haemostasis.
The biopsy site can be packed with a small piece of Gelfoam® or omentum following removal of the hepatic tissue to facilitate haemostasis. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_1_1b_thumb.gif
10.22233/9781910443248/fig9_1_1b.png
The biopsy site can be packed with a small piece of Gelfoam® or omentum following removal of the hepatic tissue to facilitate haemostasis.
The biopsy site can be packed with a small piece of Gelfoam® or omentum following removal of the hepatic tissue to facilitate haemostasis.
/content/figure/10.22233/9781910443248.chap9.figot9_1_4
The focal lesion is identified.
The focal lesion is identified. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_1_2_thumb.gif
10.22233/9781910443248/fig9_1_2.png
The focal lesion is identified.
The focal lesion is identified.
/content/figure/10.22233/9781910443248.chap9.figot9_1_5
The skin biopsy punch is pushed into the parenchyma to cut a core sample.
The skin biopsy punch is pushed into the parenchyma to cut a core sample. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_1_2a_thumb.gif
10.22233/9781910443248/fig9_1_2a.png
The skin biopsy punch is pushed into the parenchyma to cut a core sample.
The skin biopsy punch is pushed into the parenchyma to cut a core sample.
/content/figure/10.22233/9781910443248.chap9.figot9_1_6
The biopsy sample and suture packet can then be handed to a non-sterile assistant to be put into formalin.
The biopsy sample and suture packet can then be handed to a non-sterile assistant to be put into formalin. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_1_3_thumb.gif
10.22233/9781910443248/fig9_1_3.png
The biopsy sample and suture packet can then be handed to a non-sterile assistant to be put into formalin.
The biopsy sample and suture packet can then be handed to a non-sterile assistant to be put into formalin.
/content/figure/10.22233/9781910443248.chap9.figot9_1_8
Overlapping guillotine suture technique.
Overlapping guillotine suture technique. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_1_4_thumb.gif
10.22233/9781910443248/fig9_1_4.png
Overlapping guillotine suture technique.
Overlapping guillotine suture technique.
/content/figure/10.22233/9781910443248.chap9.figot9_1_10
Determine the line of separation between the normal parenchyma and that to be removed.
Determine the line of separation between the normal parenchyma and that to be removed. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_1_5_thumb.gif
10.22233/9781910443248/fig9_1_5.png
Determine the line of separation between the normal parenchyma and that to be removed.
Determine the line of separation between the normal parenchyma and that to be removed.
/content/figure/10.22233/9781910443248.chap9.figot9_1_11
Bluntly fracture the liver with fingers (or the blunt end of a scalpel handle) to expose parenchymal vessels.
Bluntly fracture the liver with fingers (or the blunt end of a scalpel handle) to expose parenchymal vessels. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_1_5a_thumb.gif
10.22233/9781910443248/fig9_1_5a.png
Bluntly fracture the liver with fingers (or the blunt end of a scalpel handle) to expose parenchymal vessels.
Bluntly fracture the liver with fingers (or the blunt end of a scalpel handle) to expose parenchymal vessels.
/content/figure/10.22233/9781910443248.chap9.figot9_1_12
Large vessels encountered during the dissection are ligated.
Large vessels encountered during the dissection are ligated. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_1_5b_thumb.gif
10.22233/9781910443248/fig9_1_5b.png
Large vessels encountered during the dissection are ligated.
Large vessels encountered during the dissection are ligated.
/content/figure/10.22233/9781910443248.chap9.figot9_1_13
A large crushing clamp can be placed across the lobe proximal to the lesion.
A large crushing clamp can be placed across the lobe proximal to the lesion. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_1_6_thumb.gif
10.22233/9781910443248/fig9_1_6.png
A large crushing clamp can be placed across the lobe proximal to the lesion.
A large crushing clamp can be placed across the lobe proximal to the lesion.
/content/figure/10.22233/9781910443248.chap9.figot9_1_14
Large overlapping mattress sutures are placed through the parenchyma of the liver.
Large overlapping mattress sutures are placed through the parenchyma of the liver. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_1_6a_thumb.gif
10.22233/9781910443248/fig9_1_6a.png
Large overlapping mattress sutures are placed through the parenchyma of the liver.
Large overlapping mattress sutures are placed through the parenchyma of the liver.
/content/figure/10.22233/9781910443248.chap9.figot9_1_15
TA55 stapler being used to perform a partial hepatic lobectomy. The stapler is placed around the portion of the lobe to be resected, the appropriate lever is pulled and the staples are fired.
TA55 stapler being used to perform a partial hepatic lobectomy. The stapler is placed around the portion of the lobe to be resected, the appropriate lever is pulled and the staples are fired. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_1_7_thumb.gif
10.22233/9781910443248/fig9_1_7.png
TA55 stapler being used to perform a partial hepatic lobectomy. The stapler is placed around the portion of the lobe to be resected, the appropriate lever is pulled and the staples are fired.
TA55 stapler being used to perform a partial hepatic lobectomy. The stapler is placed around the portion of the lobe to be resected, the appropriate lever is pulled and the staples are fired.
/content/figure/10.22233/9781910443248.chap9.figot9_1_16
Once the staples have been fired, the lobe is amputated by cutting along the edge of the staple cartridge with a scalpel. The lobe is then released and the stump is checked for bleeding.
Once the staples have been fired, the lobe is amputated by cutting along the edge of the staple cartridge with a scalpel. The lobe is then released and the stump is checked for bleeding. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_1_7a_thumb.gif
10.22233/9781910443248/fig9_1_7a.png
Once the staples have been fired, the lobe is amputated by cutting along the edge of the staple cartridge with a scalpel. The lobe is then released and the stump is checked for bleeding.
Once the staples have been fired, the lobe is amputated by cutting along the edge of the staple cartridge with a scalpel. The lobe is then released and the stump is checked for bleeding.
/content/figure/10.22233/9781910443248.chap9.figot9_2_1
In small dogs and cats, either of the left liver lobes can be removed after placing encircling ligatures around the base of the lobe in an area that has been crushed by forceps.
In small dogs and cats, either of the left liver lobes can be removed after placing encircling ligatures around the base of the lobe in an area that has been crushed by forceps. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_2_1_thumb.gif
10.22233/9781910443248/fig9_2_1.png
In small dogs and cats, either of the left liver lobes can be removed after placing encircling ligatures around the base of the lobe in an area that has been crushed by forceps.
In small dogs and cats, either of the left liver lobes can be removed after placing encircling ligatures around the base of the lobe in an area that has been crushed by forceps.
/content/figure/10.22233/9781910443248.chap9.figot9_2_3
Untitled
© 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_2_2_thumb.gif
10.22233/9781910443248/fig9_2_2.png
/content/figure/10.22233/9781910443248.chap9.figot9_2_3a
Untitled
© 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_2_2a_thumb.gif
10.22233/9781910443248/fig9_2_2a.png
/content/figure/10.22233/9781910443248.chap9.figot9_3_1
Two stay sutures are placed: one in the fundus and one in the infundibulum. These help to immobilize the gallbladder during surgical manipulation.
Two stay sutures are placed: one in the fundus and one in the infundibulum. These help to immobilize the gallbladder during surgical manipulation. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_3_1_thumb.gif
10.22233/9781910443248/fig9_3_1.png
Two stay sutures are placed: one in the fundus and one in the infundibulum. These help to immobilize the gallbladder during surgical manipulation.
Two stay sutures are placed: one in the fundus and one in the infundibulum. These help to immobilize the gallbladder during surgical manipulation.
/content/figure/10.22233/9781910443248.chap9.figot9_3_2
A large incision is made in the gallbladder so that all contents may be easily removed. Additional stay sutures can be placed on either side of the incision to facilitate access to the gallbladder lumen. (Courtesy of S Birchard)
A large incision is made in the gallbladder so that all contents may be easily removed. Additional stay sutures can be placed on either side of the incision to facilitate access to the gallbladder lumen. (Courtesy of S Birchard) © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_3_1a_thumb.gif
10.22233/9781910443248/fig9_3_1a.png
A large incision is made in the gallbladder so that all contents may be easily removed. Additional stay sutures can be placed on either side of the incision to facilitate access to the gallbladder lumen. (Courtesy of S Birchard)
A large incision is made in the gallbladder so that all contents may be easily removed. Additional stay sutures can be placed on either side of the incision to facilitate access to the gallbladder lumen. (Courtesy of S Birchard)
/content/figure/10.22233/9781910443248.chap9.figot9_4_1
A stay suture is placed in the fundus of the gallbladder. The gallbladder is then bluntly dissected from the hepatic fossa using curved Halsted mosquito forceps.
A stay suture is placed in the fundus of the gallbladder. The gallbladder is then bluntly dissected from the hepatic fossa using curved Halsted mosquito forceps. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_4_1_thumb.gif
10.22233/9781910443248/fig9_4_1.png
A stay suture is placed in the fundus of the gallbladder. The gallbladder is then bluntly dissected from the hepatic fossa using curved Halsted mosquito forceps.
A stay suture is placed in the fundus of the gallbladder. The gallbladder is then bluntly dissected from the hepatic fossa using curved Halsted mosquito forceps.
/content/figure/10.22233/9781910443248.chap9.figot9_4_2
The gallbladder is dissected away from the hepatic fossa using blunt and sharp dissection.
The gallbladder is dissected away from the hepatic fossa using blunt and sharp dissection. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_4_2_thumb.gif
10.22233/9781910443248/fig9_4_2.png
The gallbladder is dissected away from the hepatic fossa using blunt and sharp dissection.
The gallbladder is dissected away from the hepatic fossa using blunt and sharp dissection.
/content/figure/10.22233/9781910443248.chap9.figot9_4_4
The cystic duct is dissected down to the junction with the common bile duct, clamped and severed.
The cystic duct is dissected down to the junction with the common bile duct, clamped and severed. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_4_3_thumb.gif
10.22233/9781910443248/fig9_4_3.png
The cystic duct is dissected down to the junction with the common bile duct, clamped and severed.
The cystic duct is dissected down to the junction with the common bile duct, clamped and severed.
/content/figure/10.22233/9781910443248.chap9.figot9_4_5
The common bile duct is cannulated via the stump of the cystic duct and flushed to ensure patency.
The common bile duct is cannulated via the stump of the cystic duct and flushed to ensure patency. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_4_4_thumb.gif
10.22233/9781910443248/fig9_4_4.png
The common bile duct is cannulated via the stump of the cystic duct and flushed to ensure patency.
The common bile duct is cannulated via the stump of the cystic duct and flushed to ensure patency.
/content/figure/10.22233/9781910443248.chap9.figot9_4_6
Gallbladder mucocele.
Gallbladder mucocele. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_4_4a_thumb.gif
10.22233/9781910443248/fig9_4_4a.png
Gallbladder mucocele.
Gallbladder mucocele.
/content/figure/10.22233/9781910443248.chap9.figot9_5_1
Untitled
© 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_5_1_thumb.gif
10.22233/9781910443248/fig9_5_1.png
/content/figure/10.22233/9781910443248.chap9.figot9_5_2
Untitled
© 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_5_2_thumb.gif
10.22233/9781910443248/fig9_5_2.png
/content/figure/10.22233/9781910443248.chap9.figot9_5_3
Untitled
© 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_5_3_thumb.gif
10.22233/9781910443248/fig9_5_3.png
/content/figure/10.22233/9781910443248.chap9.figot9_5_5
Untitled
© 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_5_3a_thumb.gif
10.22233/9781910443248/fig9_5_3a.png
/content/figure/10.22233/9781910443248.chap9.figot9_5_6
Completed cholecystoenterostomy.
Completed cholecystoenterostomy. © 2015 British Small Animal Veterinary Association
10.22233/9781910443248/fig9_5_4_thumb.gif
10.22233/9781910443248/fig9_5_4.png
Completed cholecystoenterostomy.
Completed cholecystoenterostomy.