A case of recurrent cholangitis after bile duct injury during laparoscopiccholecystectomy: Value of scintigraphy with Tc-99m GSA and hepatobiliary scintigraphy for indication of lobectomy

A 39-year-old woman with acute cholecystitis and gallstones underwent lapar oscopic cholecystectomy. She suffered from recurrent episodes of cholangiti s due to injury of the major bile ducts during laparoscopic cholecystectomy . Hepatobiliary scintigraphy with Tc-99m Sn-N-pyridoxyl-5-methyltryptophan wa s performed. Although normal bile excretion was found from the left hepatic duct to the percutaneous transhepatic biliary drainage (PTBD) tube, excret ion from the right hepatic lobe was prolonged. Scintigraphy with Tc-99m die thylenetriaminepentaacetic acid-galactosyl human serum albumin demonstrated atrophy of the right hepatic lobe and enlargement of the left hepatic lobe . Cholangiography via the PTBD tube revealed complete obstruction of the le ft hepatico-jejunal anastomosis and could not enhance the right intrahepati c bile duct. A right hepatic lobectomy was performed because of the atrophy , glissonitis and the absence of an appropriate bile duct for reconstructio n. Postoperatively she was active and exhibited no evidence of recurrent ch olangitis.