title: Bile leak from gallbladder perforation mimicking bowel activity and a false-negative result in a morphine-augmented cholescintigraphy.
abstract: Cholescintigraphy of a patient with bile leak demonstrated intra-abdominal activity that mimicked normal bowel activity. Because the gallbladder was not visualized, morphine was injected intravenously. Gallbladder activity after morphine injection was misleading in the finding of chronic cholecystitis. Concurrent abdominal sonography and computerized tomography revealed a thickened gallbladder wall with a gallstone and pericholecystic fluid collection. Exploratory laparotomy confirmed acute and chronic cholecystitis, cholelithiasis, choledocholithiasis, and a pericholecystic abscess. The false-negative conclusion for acute cholecystitis in the patient's morphine-augmented cholescintigraphy resulted from an acceleration of bile leakage due to pre-existing gallbladder perforation.
authors.affiliation: Nuclear Medicine Service, Veterans Affairs Medical Center, Lexington, KY 40511.
authors.forename: W J
authors.initials: WJ
authors.lastname: Shih
authors.forename: S
authors.initials: S
authors.lastname: Magoun
authors.forename: B J
authors.initials: BJ
authors.lastname: Mills
authors.forename: C
authors.initials: C
authors.lastname: Pulmano
mesh_terms: D000368:Aged; D001646:Bile; D002764:Cholecystitis / Q000175:diagnosis / Q000000981:diagnostic imaging*; D002765:Cholecystography; D002769:Cholelithiasis / Q000000981:diagnostic imaging; D002908:Chronic Disease; D005188:False Negative Reactions; D005704:Gallbladder / Q000000981:diagnostic imaging*; D006801:Humans; D007422:Intestines / Q000000981:diagnostic imaging*; D008297:Male; D009020:Morphine; D011877:Radionuclide Imaging; D012422:Rupture, Spontaneous; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D009020:Morphine