MyPACS.net: Radiology Teaching Files > Case 5021239

never visited BILIARY LEAK STATUS POST CHOLECYSTECTOMY IN PATIENT WITH PRIMARY SCELORSING CHOLANGITIS
Contributed by: Arman Forouzannia.
Patient: 70 year old male
History: 70yo male with history of known Ulcerative colitis and Primary Sclerosing Cholangitis was noted to significantly dilated Gallbladder on routine CT/US.  Elected to undergo elective cholecystectomy due to increased Gallbladder Carcinoma risk with PSC.
Images:[small]larger

Fig. 1: Postoperative CT s/p Cholecytectomy.

Fig. 2: ERCP followup.

Fig. 3: HIDA scan.

Fig. 4: HIDA with drainage bag in camera view.
Findings:

Large biliary leak post cholecystectomy seen initially on CT examination which shows a comlpex fluid collection in the porta hepatis with additional free fluid noted in the perihepatic space. 

ERCP was followed demonstrating a biliary leak secondary to fistula formation from the right hepatic bilary system to the gallbladder fossa. Findings consistent with primary sclerosing cholangitis are also noted.

HIDA scan was done to determine the extent of leak which demonstrated brisk leak into the gallbladder fossa as evident by persistent and increasing tracer activity in the gallbladder fossa.  Tube like activity noted extending from the RUQ down to the RLQ and away from the patient.  This was confirmed to be the draining catheter in the gallbladder fossa draining the bile by imaging the draining bag demonstrating activity.

Diagnosis:

Right Hepatic Biliary Leak/Fistula into the gallbladder fossa status post cholecystectomy in patient with underlying Primary Sclerosing Cholangitis/Ulcerative Colitis.

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Additional Details:

Case Number: 5021239Last Updated: 06-08-2006
Anatomy: Gastrointestinal (GI)   Pathology: Iatrogenic
Modality: CT, GI, Nuc MedExam Date: Access Level: Readable by all users
Keywords: iliary bile leak cholecystectomy in patient hida primary scelorsing cholangitis

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