title: Hepatobiliary scintigraphy in detecting lesser sac bile leak in postcholecystectomy patients: the need to recognize as a separate entity.
abstract: Cholecystectomy is one of the most commonly performed abdominal surgeries in which bile duct injury and bile leaks are the most important complications. Imaging plays an important role in the prompt diagnosis and management of bile leaks. The more common sites of bile leak are the gallbladder bed, subhepatic, in a bilioma, right paracolic gutter, or diffusely in the peritoneal cavity. Bile leak into the lesser sac (LS) is uncommon but is a special entity posing difficult problems in management. We have described in this study the clinical presentation, imaging findings, and management of 6 patients with biliary leakage into the LS postcholecystectomy. The clinical presentation of this condition was varied, ranging from patients with asymptomatic or with vague complaints resulting in difficulties in clinical suspicion or symptomatic but minimal enough not to be detected by ultrasonogram. Hepatobiliary scintigraphy played an important role in the diagnosis and management, and all patients required definitive therapeutic drainage procedures. Any persistent focal radiotracer activity in the anatomy of the LS, increasing with time and not diffusing into the general peritoneal cavity is diagnostic of bile leak into the LS.
authors.affiliation: Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Vijay Babu
authors.initials: VB
authors.lastname: Balakrishnan
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kumar
authors.forename: Halanaik
authors.initials: H
authors.lastname: Dhanpathi
authors.forename: Murali
authors.initials: M
authors.lastname: Nadig
authors.forename: Tushar
authors.initials: T
authors.lastname: Mohapatra
authors.forename: Chandra Sekhar
authors.initials: CS
authors.lastname: Bal
authors.forename: Arun
authors.initials: A
authors.lastname: Malhotra
mesh_terms: D000328:Adult; D000814:Aniline Compounds; D001652:Bile Ducts / Q000000981:diagnostic imaging* / Q000293:injuries; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D005998:Glycine; D006801:Humans; D007098:Imino Acids; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D010529:Peritoneal Cavity / Q000000981:diagnostic imaging*; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals
chemical_list: D000814:Aniline Compounds; D007098:Imino Acids; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C034837:technetium Tc 99m mebrofenin; D005998:Glycine