HEPATOBILIARY SCINTIGRAPHY FOR THE DIAGNOSIS OF BILE LEAKS PRODUCED AFTER T-TUBE REMOVAL IN ORTHOTOPIC LIVER-TRANSPLANTATION

Choledochocholedochostomy (CC) over a T-tube is a well-recognized tech nique for biliary reconstruction in orthotopic liver transplantation ( OLT). Bile leaks after T-tube removal are common, having a significant morbidity. The aim of this study was to evaluate the utility of hepat obiliary scintigraphy (HBS) for diagnosing bile leaks in liver transpl ant patients who develop abdominal pain after T-tube removal. Twenty c onsecutive patients (14 males, 6 females; mean age 44 years) were stud ied. The interval between T-tube removal and HBS ranged from 8 to 120 h. Hepatobiliary scintigraphy was carried out after the intravenous in jection of 185 MBq Tc-99(m)-mebrofenin. A final diagnosis of bile leak was based on surgical, endoscopic retrograde cholangiopancreatography (ERCP) and ultrasound data, and clinical outcome. There were 13 patie nts with and 7 without bile leaks. On the scintigraphic images, bile l eaks were defined as activity outside the biliary tract which moved al ong the right paracolic gutter, or the progressive accumulation of act ivity related to fluid collections as seen on ultrasound. Nine of 12 p atients needed surgical repair; the other 3 were treated with endoscop ic sphincterotomy. One patient with a negative HBS developed an abdomi nal abscess after aspirative puncture of a biloma. In the seven patien ts without bile leaks, all scintigrams showed normal biliary transit o f activity. A diagnosis of no bile leaks was based on clinical follow- up in five patients and by ERCP in two patients. Based on these result s, we conclude that HBS is an effective method for the diagnosis of bi le leaks after T-tube removal in liver transplant patients. ((C) 1998 Chapman & Hall Ltd.).