Hepatobiliary scintigraphy as a primer in the diagnosis and management of biliary tract injuries

Background: Biliary tract injuries are seen following various causes that include laparoscopic cholecystectomy, blunt abdominal trauma, penetrating abdominal injuries and operative procedures performed for choledochal cyst and cholangiocarcinoma. Early diagnosis and optimal management is very import...

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Bibliographic Details
Published inThe Journal of nuclear medicine (1978) Vol. 59; p. 161
Main Authors Kousik, Vankadari, Bhattacharya, Anish, Mittal, Bhagwant, Yadav, Thakur
Format Journal Article
LanguageEnglish
Published New York Society of Nuclear Medicine 01.05.2018
Subjects
Abdomen
Bile
Biliary tract
Cholangiocarcinoma
Cholecystectomy
Collection
Computation
Computed tomography
Diagnosis
Gallbladder diseases
Image acquisition
Injuries
Injury analysis
Intervention
Intravenous administration
Laparoscopy
Management
Medical diagnosis
Medical imaging
Morbidity
Mortality
Ostomy
Patients
Photon emission
Scintigraphy
Single photon emission computed tomography
Tomography
Trauma
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Summary:Background: Biliary tract injuries are seen following various causes that include laparoscopic cholecystectomy, blunt abdominal trauma, penetrating abdominal injuries and operative procedures performed for choledochal cyst and cholangiocarcinoma. Early diagnosis and optimal management is very important to avoid morbidity / mortality in missed or delayed diagnosis. Objectives : This study discusses the image findings and role of hepatobiliary scintigraphy (HBS) in the management of biliary tract injuries.Materials and methods : We retrospectively analysed the scan findings of 54 patients (28M, 26F) aged 3 -78 years with evidence of bile leak on HBS from 2015 - 2017. Early dynamic acquisition (30 sec/ frame) was performed for 30 minutes following intravenous injection of Tc99m mebrofenin, with subsequent static images acquired till 24 hours. Single photon emission computed tomography-computed tomography (SPECT/CT) acquisition was done in all cases with suspicion of biliary leak on the planar images. Based on the time of appearance of the leak and change in the intensity on subsequent static images, we divided the patients in our study into those with active major bile leak and minimal leak. In patients with a drain placed in the abdominal collection, the drain output was also documented. The statistical significance of the drain output in patients with imaging evidence of active leak versus minimal leak was assessed using the Mann-whitney test. The subsequent management of all patients included in this study was also documented. Results : Of the 54 patients included in the study, 28 patients had evidence of active bile leak and 26 patients demonstrated minimal leak on HBS. Thirty four patients (24 with active leak and 10 with minimal leak) had a drain placed in the abdomen for draining the fluid collection. The mean drain output in ml/ day/ patient was significantly higher in patients with imaging evidence of active leak compared to patients with minimal leak (370 vs 78, P <0.01). All the patients with active bile leak underwent intervention with ERCP and stenting or Roux - en-Y hepatico-jejunostomy. Patients with evidence of minimal bile leak were managed conservatively without any intervention and were free of symptoms at one year follow-up. Conclusion: Our findings indicate that, in addition to detecting active biliary leaks HBS can be used to differentiate patients with minimal biliary leak (48% of patients in our study) in whom no active intervention is required from those who require active intervention.
ISSN:0161-5505
1535-5667