MR imaging of upper abdomen following cholecystectomy - Normal and abnormal findings

Purpose: To describe the normal MR appearance after cholecystectomy and the findings in patients with postoperative complications using fast pulse seq uences in abdominal MR imaging. Material and Methods: In a prospective study of 119 patients, 64 were exami ned with MR after cholecystectomy. In total, 56 patients with uncomplicated cholecystectomy were examined with MR 1-5 days (mean 1.6 days) after chole cystectomy. Nine patients had an abdominal postoperative complication and 8 of these were examined with MR after the complication commenced 1-12 days after the cholecystectomy. Results: Oedema in the gallbladder fossa was the only finding in 39 patient s (61%), all with uneventful recovery. Small fluid collections in an area c onsistent with the gallbladder fossa were seen in 9/64 (14%) patients, of w hich 3 had surgical complications: 1 bleeding and 2 bile duct leakage. Twen ty-two (34%) patients had small locally situated fluid collections adjacent to the liver, 14 were uneventful and 8 showed postoperative surgical compl ications. Seven patients had fluid in the rest of the abdomen of which 5 ha d surgical complications; 4 due to bile duct leakage and 1 acute pancreatit is. One patient had a postoperative bleeding not seen on MR images. Conclusion: MR is very sensitive in detecting fluid collections. Early MR f indings following cholecystectomy are normally only subtle changes, mainly in the gallbladder fossa. Fluid collections diagnosed elsewhere than in the gallbladder fossa usually indicate a surgical complication and a surgical complication is unlikely if MR fails to show a fluid collection.