POSITIONAL BILIARY STASIS - SCINTIGRAPHIC FINDINGS FOLLOWING BILIARY ENTERIC BYPASS-SURGERY

Hepatobiliary scintigraphy has proven to be a reliable noninvasive ima ging modality to evaluate postoperative biliary obstruction, which is a frequent complication following biliary enteric bypass surgery. We p resent a case of a patient who had biliary enteric bypass surgery with a scintigraphic pattern simulating partial obstruction on a Tc-99m he patobiliary study performed with the patient in a supine position. The biliary stasis seen in the supine images disappeared almost completel y when the images were repeated after 30 min in an upright position. P rogressive accumulation of activity initially seen in the region of th e biliary enteric anastomosis was not present 3 days later on a repeat study with the patient in an upright position, confirming that biliar y stasis in this patient was due to a positional phenomenon. This case illustrates that biliary stasis may be positional in nature. Position related stasis should be a consideration when interpreting hepatobili ary scintigraphic studies in postoperative patients and when suspected , patients should be imaged in the upright position.