American Journal of Roentgenology, Vol 155, 789-794, Copyright © 1990 by American Roentgen Ray Society
Sonography accurately detects biliary obstruction in patients with surgically created biliary-enteric anastomosis
SR Wilson and A Toi
Department of Radiology, Toronto General Hospital, Ontario, Canada.
The use of sonography to determine the patency of surgically created
biliary-enteric anastomoses has been questioned by authors who favor use of
cholescintigraphy and percutaneous transhepatic cholangiography for this
purpose. We retrospectively reviewed the sonographic findings in 35
patients with such anastomoses: 16 choledochojejunostomies, 11
choledochoduodenostomies, five intrahepatic cholangiojejunostomies, and
three cholecystoenterostomies. The anastomosis was patent in 25 patients,
completely obstructed in four, and partially obstructed in six. Five of the
25 patients with patent anastomoses had nonanastomotic complications with
biliary stasis and cholangitis. In the 20 patients with patent anastomoses
and no complication, sonography showed bile ducts ranging from 2 to 9 mm in
diameter filled with bile (six), gas (two), or both (12). No patient with a
normally functioning anastomosis had evidence of a dilated bile-filled duct
in the upright position. In four patients with complete obstruction of the
anastomosis, sonography showed dilated, bile-filled ducts ranging from 6 to
14 mm in diameter proximal to the anastomosis. Sonograms in all six
patients with partial obstruction showed both gas and bile in dilated bile
ducts with superficial gas-filled ducts and dependent bile-filled ducts
creating gas/fluid interfaces, which were persistent in the upright
position. The 15 patients with anastomotic obstruction or other
complication had confirmatory percutaneous transhepatic cholangiography
(nine patients), scintigraphy (five patients), CT (four patients), and
surgery (eight patients). Our experience suggests that sonography can be
used to accurately assess surgically created biliary-enteric anastomoses
for both anastomotic patency and for other complications.
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