Biliary complications related to laparoscopic cholecystectomies: radiologic diagnosis and management.
The purpose of this study was to review the radiologic presentations and management of biliary complications related to laparoscopic cholecystectomies. Additionally, a computed tomography (CT) evaluation of asymptomatic postsurgical patients was performed to determine the uncomplicated appearance of the gallbladder fossa. Over a 24-month period 23 biliary complications were seen in patients who underwent laparoscopic cholecystectomies (group 1). Twenty asymptomatic patients were examined with unenhanced CT examinations after laparoscopic cholecystectomy (group 2). Twenty patients in group I had bilomas located in the gallbladder fossa (n = 9), subhepatic (n = 7) and subphrenic (n = 2) spaces, and diffusely distributed in the peritoneal cavity (n = 2). The bile leaks were presumed to have been proved to be from the cystic duct (n = 19), right hepatic duct (n = 1), and common bile duct n = 3) injuries and leaks. Fourteen drains were placed percutaneously using CT (n = 12) or sonographic (n = 2) guidance, and in two cases drains were placed surgically. The duration of catheter drainage average 11.3 days. Six patients underwent endoscopic retrograde cholangiopancreatography (ERCP) procedures, including sphincterotomy (n = 6) and stent placement (n = 3). Patients who were treated with a drain or ERCP procedures or who were managed conservatively all recovered without the need for additional surgery. In five cases, the bile cultures were positive for multiple organisms. Three patients underwent surgical repairs for disrupted common bile ducts. In group 2 CT examinations showed minimal fluid densities in all patients. No evidence of distinct, well-demarcated fluid collection was seen in any of the 20 patients. (ABSTRACT TRUNCATED AT 250 WORDS)
Quinn
S F
SF
Department of Radiology, Good Samaritan Hospital, Portland, OR 97210.
Sangster
W
W
Standage
B
B
Schuman
E
E
Gross
G
G
D001646:Bile; D001652:Bile Ducts / Q000293:injuries; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D002758:Cholangiography; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D004322:Drainage; D006801:Humans; D015607:Stents; D014057:Tomography, X-Ray Computed