Viewing as Unknown - Click [Caption Peek] to Read Caption - MedPix™: 54182

Please Choose an Item from the List

(Click each item)

History:

This 56 y.o. man had a laparoscopic cholecystectomy for acute cholecystitis. Due to significant inflammatory changes, the procedure was converted to an open cholecystectomy. Nine days later, he presents with shortness of breath and abdominal pain.

Exam:

Not Provided

Image Findings:

• CT scan performed 9 days post cholecystectomy shows subcapsular fluid displacing the liver medially.

• Hepatobiliary scan obtained one day after the above CT scan demonstrated progressive accumulation of radiotracer surrounding the right hepatic lobe and the dome of the liver. This corresponds to the large collection seen on the CT scan of the abdomen. The radiotracer flowed through a drain with a subsequent decrease in the activity surrounding the right hepatic lobe and the dome.

• ERCP demonstrated extravasation of contrast originating from the cystic duct remnant. The surgical clips did not ligate the cystic duct remnant and is responsible for causing the bile leak.

Differential Diagnosis:

• Hepatic Pseudocyst
• Hepatic Subcapsular Hematoma
• Biloma (bile collection)
• Abscess

Actual Diagnosis:

Biloma, after cholecystectomy

How Was Dx Confirmed:

ERCP confirmed extravasation of contrast from the cystic duct.

Treatment and Outcome:

A hepatobiliary scan revealed radiotracer uptake surrounding the liver consistent with a bile leak into a biloma with subsequent drainage through the right upper quadrant drain.

An ERCP confirmed extravasation of contrast from the cystic duct.

During the ERCP, a biliary stent was placed. A follow-up CT performed 6 days after the ERCP showed near complete resolution of the subcapsular fluid.

Patient Discussion:

CT scans detect perihepatic fluid well, but they fail to accurately identify whether the fluid is bilious or, more importantly, if the fluid arose from a communication with the biliary tree. Tc-99m labeled hepatobiliary scanning is a well-known modality that provides excellent physiologic evaluation of bile leaks.

Postcholecystectomy Biloma Assessment with Hepatobiliary Imaging

Bilomas are a well known and well documented complication of open cholecystectomies. CT scans detect perihepatic fluid well, but they fail to accurately identify whether the fluid is bilious or, more importantly, if the fluid arose from a communication with the biliary tree. Tc-99m labeled hepatobiliary scanning is a well-known modality that provides excellent physiologic evaluation of bile leaks.

** Click Here -

- for the Complete Topic **