[Post-cholecystectomy syndrome: hepatobiliary scintigraphy and cholangiopancreatography with magnetic resonance in 5 consecutive patients. Comparison of results and integrated diagnosis].
OBJECTIVE
To investigate the clinical effectiveness of combined hepatobiliary scintigraphy (HBS) and MR-cholangiopancreatography (MRCP) studies in the postcholecystectomy syndrome.


METHODS
June 1997, to February 1998, we examined with HBS and MRCP five women, three of them submitted to surgical and two to laparoscopic cholecystectomy. All patients had biliary pain but no changes in cholestasis and liver function blood parameters. After at least 4 hours' fasting HBS was performed dynamically, for one hour, injecting a 185 MBq 99mTc-mebrofenin bolus i.v. A fatty meal was given at the end of the basal test and serial static images were acquired till complete biliary washout.


RESULTS
MRCP was normal in one case while in the others it showed biliary tree dilation, severe stricture of the distal common bile duct (CBD) and marked enlargement of the remnant cystic duct (RCD), which lodged a 6-mm stone in one patient. Pancreatic ducts were regular. HBS showed delayed biliary transit in all patients, which was however completed within 3 hours of injection, favored by the fatty meal. The RCD was not injected in three cases. Finally, HBS detected an early liver dysfunction in three cases.


CONCLUSIONS
HBS and MRCP allow to evaluate the biliary tree function and anatomy, respectively, adding further data on liver function and pancreatic duct morphology. We detected associated functional and organic biliary alterations which were the likely cause of postcholecystectomy pain, such as severe spasm in Oddi's sphincter, nonpatent enlarged RCD and RCD stones. Moreover, HBS detected an early liver dysfunction in three cases. In conclusion, combined HBS and MRCP studies make a noninvasive, simple and accurate diagnostic approach in postcholecystectomy syndrome and for the screening of patients needing prompt surgical treatment.
Dimonte
M
M
Sezione di Medicina Nucleare, Diagnostica per Immagini Calabrese, Lecce.
Calabrese
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R
D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D017562:Postcholecystectomy Syndrome / Q000000981:diagnostic imaging* / Q000473:pathology*; D011877:Radionuclide Imaging