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HISTORY:
A 54-year-old, white female, who was admitted to the hospital after
she presented to the emergency room with increasing belly pain that
began several days after she had had a laparoscopic cholecystectomy
that was performed at another hospital. She denied any vomiting, but
stated that she had had some nausea. The patient stated that she had
had a bowel movement the day prior to admission.
HOSPITAL COURSE:
The patient was admitted on Day 1. CT scan was obtained which showed
an incarcerated hernia at a trocar site and a small amount of free
fluid within the abdomen. The hernia appeared to contain some omentum
but the patient did have an elevated white count so it was decided to
take the patient to the operating room for repair of the hernia. The
patient was taken to the OR on Day 2 for an open repair of the
incarcerated incisional hernia and drain into the fluid during the
procedure, a small amount of bilious fluid was noted within Morrison's
pouch. Two drains were placed, see the operative note for further
details of the procedure. The patient recovered well from the
procedure and was transferred to the floor. On Day 3, a HIDA [Mebrofenin]
scan was obtained which showed a small biliary leak.
Radiology Report: HEPATOBILIARY STUDY
A 54 year old white female with status post laparoscopic
cholecystectomy five days ago. Study performed to evaluate for
possible biliary leak.
8.3 mCi of 99mTc Choletec was administered via IV. Sixty minutes
following IV injection, sequential planar images were obtained through
the anterior abdomen.
Activity of the radiotracer is prompt and homogenous throughout the
liver. No evidence of gallbladder filling is noted. However,
radiotracer pooling is noted in the gallbladder fossa, as well as
right paracolic gutter. This is consistent with biliary leak.
Gastrointestinal tract activity is noted.
IMPRESSION: BILIARY LEAK WITH POOLING WITHIN THE GALLBLADDER FOSSA AND
RIGHT PARACOLIC GUTTER.
We decided to obtain an ERCP to further evaluate the
leak which showed a leak from the cystic stunt. Stent was placed after
a partial sphincterotomy. Following ERCP, the patient's diet was
slowly advanced, which she tolerated well. Drains lessened the amount
of fluid they were draining out and they were eventually discontinued.
The patient was discharged on Day 13, after she was tolerating a diet
and doing well with no abdominal pain, fever or other symptoms. She
was discharged to home in good condition.
MEDICATIONS AT DISCHARGE:
The patient was given a prescription for Percocet for pain control.
INSTRUCTIONS:
The patient was instructed to call or return for fever, nausea,
vomiting or other concerns.
FOLLOW UP:
The patient is to follow up in surgery clinic in two weeks.
© 2004 Nuclear Education Online
- Images courtesy of UAMS Dept of
Nuclear Medicine.
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