Boban, a 14-year-old American Eskimo Dog, was presented to AVES Emergency Service after experiencing several days of vomiting, anorexia, and progressive lethargy. His family reported that his last known meal was nearly a week prior, and he had not urinated or defecated for several days. On presentation, Boban was quiet but responsive, with notable icterus of the mucous membranes, sclera, and skin, as well as a tense cranial abdomen. Initial laboratory work revealed marked hyperbilirubinemia, severe elevations in ALT and ALP, and mild azotemia. An AFAST performed at triage confirmed gallbladder distension with significant organized debris but no free abdominal fluid.

Given his clinical signs, laboratory abnormalities, and imaging findings, gallbladder mucocele with extrahepatic biliary obstruction was the primary working diagnosis. Boban was hospitalized for intensive stabilization including intravenous fluid therapy, antiemetics, analgesia via fentanyl CRI, and broad-spectrum antibiotics. Because of his fragile clinical status and age, surgery was deferred until he could be further stabilized. Over the next several days, his liver values improved moderately, and azotemia resolved, allowing safe progression to surgery.

Boban underwent cholecystectomy and liver biopsy under general anesthesia. Intraoperatively, his gallbladder was found to be large and firm, though no evidence of rupture was present. The cystic duct was carefully dissected and ligated, and a standard cholecystectomy was performed. Mild liver nodularity was noted, and liver biopsies were collected concurrently. He recovered uneventfully from anesthesia and was monitored post-operatively in our critical care unit.

In the days following surgery, Boban developed a significant incisional dehiscence requiring surgical wound debridement and tie-over bandage placement. Culture of the surgical wound and gallbladder both grew a multidrug-resistant strain of Enterobacter cloacae, resistant to nearly all antibiotics except aminoglycosides and chloramphenicol. Antibiotic therapy was transitioned to amikacin while renal parameters were monitored daily. Unfortunately, transient azotemia developed, likely secondary to aminoglycoside nephrotoxicity, but responded well to aggressive IV fluid therapy and resolved with continued monitoring.

Further complicating his recovery, follow-up abdominal ultrasound identified a suspected intra-abdominal abscess adjacent to the spleen. Fine needle aspiration revealed no evidence of bacterial infection, and medical management was elected, with successful resolution over time.

Throughout Boban’s hospitalization, collaborative care across multiple specialty departments was critical to his successful outcome. The emergency and critical care team provided acute stabilization and daily supportive management. The surgical team performed advanced biliary surgery and later wound management procedures. Internal medicine consultation provided guidance in managing the complex multidrug-resistant infection and ongoing hepatic monitoring. Our ICU nursing team ensured close observation of hydration status, renal values, and comfort throughout his extended recovery.

After several weeks of intensive inpatient care followed by outpatient monitoring, Boban made a full recovery. His liver values stabilized, his surgical wound healed beautifully, and he was successfully weaned off antibiotics. Three years later, at 17 years of age, Boban remains happy at home with his family, enjoying life well beyond his original prognosis.

In a touching note years later, Boban’s family shared how grateful they were to the entire AVES team, expressing that the advanced care and dedication of the doctors and nurses had given them three extra wonderful years with their beloved companion. Their message was filled with heartfelt gratitude, describing how much joy Boban continued to bring to their lives and how deeply they appreciated every effort made on his behalf.

Boban’s case exemplifies the capabilities of modern veterinary specialty care: advanced imaging, surgical expertise, infectious disease management, critical care monitoring, and comprehensive nursing support all coordinated through a fully integrated multidisciplinary team. Cases like Boban’s demonstrate how complex geriatric patients can successfully recover from severe hepatobiliary disease and secondary complications when provided with timely, collaborative, and individualized care.