CHOLESCINTIGRAPHY IN THE DIAGNOSIS OF BILE LEAK AFTER LAPAROSCOPIC CHOLECYSTECTOMY

Bile leaks are a recognized complication of laparoscopic cholecystecto my (LC). Different diagnostic approaches have been employed when this condition is suspected. We present our experience with cholescintigrap hy as a primary imaging technique for the detection of bile leaks. The medical records of all patients who had cholescintigraphy after LC du ring a 58-month period were reviewed. Patients were selected for chole scintigraphy if fever, unusual abdominal pain, nausea, vomiting, or ja undice were present beyond 36 hours after LC. Bile leaks were suspecte d in 25 out of 744 patients (3.36%). The nuclear imaging study was tru e positive in 7 cases and true negative in 18 cases, for a 100 per cen t sensitivity, specificity, and accuracy in the detection of bile leak s. Five patients were treated by endoscopic retrograde cholangiopancre atography with stent and/or sphincterotomy, and two patients underwent exploratory laparotomy. None of the patients who underwent endoscopic retrograde cholangiopancreatography required peritoneal drainage. We conclude that cholescintigraphy is sensitive and accurate in the diagn osis of bile leaks. Its use along with a high index of suspicion of a bile leak may prevent the development of bile peritonitis.