Case Author(s): Tate Allen, M.D. and Tom R. Miller, M.D., Ph.D. , 9/11/98 . Rating: #D2, #Q4

Diagnosis: Biliary Leak

Brief history:

Abdominal pain in a liver transplant patient

Images:

Hepatobiliary Scintigraphy

View main image(hs) in a separate image viewer

View second image(fl). ERCP

Full history/Diagnosis is available below

Diagnosis: Biliary Leak

Full history:

This is a 51 year-old man who underwent liver transplantation for hepatitis C three months ago. The pateint's T-tube was removed one day prior to this examination. After the tube was removed, the patient has had worsening abdominal pain.

Radiopharmaceutical:

3.3 mCi Tc-99m mebrofenin i.v.

Findings:

The hepatobiliary study shows leakage of tracer at the choledochocholedochostomy into the gallbladder fossa, right sub-hepatic space, and the right pericolic gutter. An ERCP was performed after this study. It showed contrast exiting the common bile duct through the T-tube tract (small white arrows) and pooling in the abdominal wall of the patient (large white arrow). At fluroscopy, contrast was also identified flowing into the paritoneal cavity.

Discussion:

Also see cases hs006, hs 009, and hs011.

Followup:

A stent was placed in the bile duct crossing the surgical anastomosis.

View followup image(fl). Stent across the bile duct

ACR Codes and Keywords:

References and General Discussion of Hepatobiliary Scintigraphy (Anatomic field:Gasterointestinal System, Category:Inflammation,Infection)

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Case number: hs014

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