"Cholescintigraphy is demonstrated to be a sensitive and specific test for free or contained biliary leakage. Its main limitation is in generating spatial resolution and thus hinders planning the appropriate treatment; this may partially be overcome with fusion imaging such as SPECT/CT. Accumulation of radiotracer anatomically distant to the bowel is suggestive of a local bile leak (biloma); however, it may be challenging to differentiate. Careful interpretation is required based on the clinical context; for example, post-roux-en-Y procedure, there may be usual radiotracer accumulation in the blind end of the roux limb, and this may be misinterpreted for a bile leak 6."
"Cholescintigraphy is demonstrated to be a sensitive and specific test for free or contained biliary leakage. Its main limitation is in generating spatial resolution and thus hinders planning the appropriate treatment; this may partially be overcome with fusion imaging such as SPECT/CT. Accumulation of radiotracer anatomically distant to the bowel is suggestive of a local bile leak (biloma); however, it may be challenging to differentiate. Careful interpretation is required based on the clinical context; for example, post-roux-en-Y procedure, there may be usual radiotracer accumulation in the blind end of the roux limb, and this may be misinterpreted for a bile leak 6."
"liver lacerations (see AAST liver injury scale)"
"ERCP"
"ERCP, while more invasive, can facilitate both diagnosis and simultaneous treatment, such as the placement of biliary stents or drainage catheters. The exact location of the disruption to the biliary system may be visualised by contrast extravasation at the injury site. The biliary system is evaluated distal to the level of injury using this technique. Thus its main limitation is that it does not allow evaluation of the proximal segments to a major duct transection/ligation injury, which may require percutaneous transhepatic cholangiography (PTC) to assess the biliary system proximal to such injuries 9."
"MR cholangiopancreatography (MRCP)"
"Active extravasation of hepatobiliary contrast material outside of typical biliary tree anatomy"
"Pooling of contrast material within an intrahepatic or perihepatic fluid collection"
"ERCP, while more invasive, can facilitate both diagnosis and simultaneous treatment, such as the placement of biliary stents or drainage catheters. The exact location of the disruption to the biliary system may be visualised by contrast extravasation at the injury site. The biliary system is evaluated distal to the level of injury using this technique. Thus its main limitation is that it does not allow evaluation of the proximal segments to a major duct transection/ligation injury, which may require percutaneous transhepatic cholangiography (PTC) to assess the biliary system proximal to such injuries 9."
Expected headings
"Hepatobiliary scintigraphy"
"MR cholangiopancreatography (MRCP)"
"ERCP"
"Percutaneous transhepatic cholangiography (PTC)"
"Bile duct injuries may be identified at the time of laparoscopic cholecystectomy during the dissection when unexpected bile leakage is directly visualised. However, most patients with a major bile duct injury are not recognised intraoperatively but present in a delayed manner in the first few weeks following the index operation with a constellation of postoperative fever, right upper quadrant abdominal pain, focal or generalised peritonitis, or cholangitis with obstructive jaundice. Biochemically, a pattern of LFT derangement accompanied by rising or persistently elevated serum bilirubin levels will be observed throughout the illness 4."
"CT is often used first-line; however, the findings may be non-specific, with secondary findings being the only clues:"
"Cholescintigraphy is demonstrated to be a sensitive and specific test for free or contained biliary leakage. Its main limitation is in generating spatial resolution and thus hinders planning the appropriate treatment; this may partially be overcome with fusion imaging such as SPECT/CT. Accumulation of radiotracer anatomically distant to the bowel is suggestive of a local bile leak (biloma); however, it may be challenging to differentiate. Careful interpretation is required based on the clinical context; for example, post-roux-en-Y procedure, there may be usual radiotracer accumulation in the blind end of the roux limb, and this may be misinterpreted for a bile leak 6."
"Cholescintigraphy is demonstrated to be a sensitive and specific test for free or contained biliary leakage. Its main limitation is in generating spatial resolution and thus hinders planning the appropriate treatment; this may partially be overcome with fusion imaging such as SPECT/CT. Accumulation of radiotracer anatomically distant to the bowel is suggestive of a local bile leak (biloma); however, it may be challenging to differentiate. Careful interpretation is required based on the clinical context; for example, post-roux-en-Y procedure, there may be usual radiotracer accumulation in the blind end of the roux limb, and this may be misinterpreted for a bile leak 6."
"Cholescintigraphy is demonstrated to be a sensitive and specific test for free or contained biliary leakage. Its main limitation is in generating spatial resolution and thus hinders planning the appropriate treatment; this may partially be overcome with fusion imaging such as SPECT/CT. Accumulation of radiotracer anatomically distant to the bowel is suggestive of a local bile leak (biloma); however, it may be challenging to differentiate. Careful interpretation is required based on the clinical context; for example, post-roux-en-Y procedure, there may be usual radiotracer accumulation in the blind end of the roux limb, and this may be misinterpreted for a bile leak 6."