The utility of CT for predicting bile leaks in hepatic trauma

LeBedis, Christina A.; Anderson, Stephan W.; Mercier, Gustavo; Kussman, Steven; Coleman, Stephanie L.; Golden, Louis; Penn, David R.; Uyeda, Jennifer W.; Soto, Jorge A.

doi:10.1007/s10140-014-1262-9

Cited by 24 publications

(15 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although, the presence of free fluid is sensitive, it is non-specific for bile leak. In a recent study of liver lacerated patients, CT scanning showed 98% hemoperitoneum but only 25% had bile leak [12].…”

Section: Discussionmentioning

confidence: 95%

Case Report Blunt Trauma: An Uncommon Cause of Bile Duct Injury

Arpit¹

2017

MJCCS

View full text Add to dashboard Cite

Disruption of the biliary tree secondary to blunt trauma is a rare cause for extrahepatic bile duct injury [1][2][3][4]. It seldom occurs alone, hence, this type of injury is easily overshadowed by more overt surgical emergencies and may go undiagnosed, leading to complications and potentially adverse outcomes in the later course. The incidence of bile leaks following hepatobiliary trauma ranges from 0.5 to 2.1% depending on the methods used to diagnose the bile leak. We present here a rare case with injury to both IHBR (Intrahepatic Biliary Radicles) and EHBD (Extra hepatic Bile Ducts) as a consequence to abdominal trauma.

show abstract

Section: Discussionmentioning

confidence: 95%

Case Report Blunt Trauma: An Uncommon Cause of Bile Duct Injury

Arpit¹

2017

MJCCS

View full text Add to dashboard Cite

show abstract

“…However, there are limitations to emergency MRCP, including lack of readily available MR imaging equipment, technologists, personnel experienced with interpreting MRCP, and higher cost (4). Therefore, HBS is the commonly used modality to diagnose biliary injury (1).…”

Section: Discussionmentioning

confidence: 99%

“…HBS can determine whether a fluid collection seen on ultrasound or CT is of biliary origin (1,2). HBS can determine the rate of leakage and can be used as a follow-up tool (1,2).…”

Section: Discussionmentioning

confidence: 99%

“…HBS can determine whether a fluid collection seen on ultrasound or CT is of biliary origin (1,2). HBS can determine the rate of leakage and can be used as a follow-up tool (1,2). A common finding of a bile leak is the radiopharmaceutical's progressive accumulation outside the biliary system, either localized (bilomas) or diffuse.…”

Section: Discussionmentioning

confidence: 99%

“…Hepat obiliary scintigraphy (HBS) is a widely used modality to diagnose biliary injury (1). In patients with a history of trauma or surgery, the common presentations of bile leaks on HBS are a progressive collection of radiotracer outside the biliary system (2).…”

mentioning

confidence: 99%

See 2 more Smart Citations

Precise Localization of a Bile Leak with Hepatobiliary Scintigraphy

Naeem

Yang

2015

J. Nucl. Med. Technol.

View full text Add to dashboard Cite

Hepatobiliary scintigraphy (HBS) is a widely used modality to diagnose biliary injury. In patients with a history of trauma or surgery, the common presentations of bile leaks on HBS are a progressive collection of radiotracer outside the biliary system. However, the precise localization of a bile leak is usually not conveyed by noninvasive techniques including CT or ultrasound or even HBS. This case study of a patient with liver trauma demonstrates a direct bile leak sign leading to recognition of an exact bile leakage site from the left intrahepatic duct. This diagnosis helped clinicians perform less-invasive management. Hepat obiliary scintigraphy (HBS) is a widely used modality to diagnose biliary injury (1). In patients with a history of trauma or surgery, the common presentations of bile leaks on HBS are a progressive collection of radiotracer outside the biliary system (2). However, the precise localization of a bile leak is usually not conveyed by noninvasive techniques including CT or ultrasound or even HBS (3,4). CASE REPORTA 16-y-old male (who along with his parent gave permission to use the data from his studies for our article) presented with injuries from a motor vehicle accident. A CT scan of the abdomen/pelvis with contrast demonstrated central hepatic laceration with extension into gallbladder fossa and peritoneal fluid. HBS was required to determine whether a biliary injury was present or not.After intravenous administration of 99m Tc-mebrofenin, sequential dynamic abdominal images were obtained over 60 min (Fig. 1). Images showed an area with decreased activity over the region between the 2 hepatic lobes, corresponding with the known hepatic laceration seen on the CT (Fig. 2). Over time, there was a progressive accumulation of tracer outside the biliary system over the inferior left hepatic lobe. A couple of lines of tracer uptake connected this abnormal focal area to the left intrahepatic duct. Eventually, this abnormal tracer accumulation spread throughout the abdomen. These findings indicated an exact bile-leaking site at the left intrahepatic duct.Subsequently an endoscopic retrograde cholangiopancreatography with initial cholangiogram confirmed the findings of the HBS (Fig. 3). Sphincterotomy and placement of 2 common bile duct stents were performed. Soon after, a diagnostic laparoscopy further confirmed a bile leak from the left hepatic duct, and a laparoscopic lavage and intraperitoneal drainage were performed. The patient did well postoperatively and was discharged with no extravasation of contrast in the follow-up endoscopic retrograde FIGURE 1. HBS over 60 min shows area with decreased activity over region between the 2 hepatic lobes, corresponding with known hepatic laceration seen on CT (black arrow). Over time, there is a progressive accumulation of tracer outside the biliary system over inferior left hepatic lobe (pink arrow). A couple of lines of tracer uptake (red arrows) connected this abnormal focal area to left intrahepatic duct. Eventually, this abnormal tracer accumulation ...

show abstract