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Imaging-Guided Catheter Drainage of Abdominal Collections with Fistulous Pancreaticobiliary Communication

Ajay K. Singh1,2, Debra A. Gervais2, Lea M. Alhilali2, Peter F. Hahn2 and Peter R. Mueller2

1 Division of Abdominal Imaging, University of Massachusetts Memorial Medical Center, 55 Lake Avenue North, Worcester, MA 01655.
2 Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Boston, MA 02114.


Figure 1
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  		Fig. 1A —Posttraumatic biloma with cystic duct communication in 28-year-old man. Contrast-enhanced CT scan shows large subhepatic biloma (arrows) extending into anterior pararenal space.

 

Figure 2
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  		Fig. 1B —Posttraumatic biloma with cystic duct communication in 28-year-old man. ERCP image shows leakage (arrows) of contrast material from cystic duct into subhepatic biloma.

 

Figure 3
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  		Fig. 1C —Posttraumatic biloma with cystic duct communication in 28-year-old man. Postprocedure CT scan shows drainage catheter and decrease in size of collection (arrow).

 

Figure 4
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  		Fig. 1D —Posttraumatic biloma with cystic duct communication in 28-year-old man. Follow-up CT scan shows successful resolution of infrahepatic biloma.

 

Figure 5
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  		Fig. 2A —Pancreatic pseudocyst with pancreatic ductal communication in 27-year-old woman. Unenhanced CT scan shows lesser sac pseudocyst (arrows) and guiding needle tip in center of collection.

 

Figure 6
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  		Fig. 2B —Pancreatic pseudocyst with pancreatic ductal communication in 27-year-old woman. Pseudocyst catheter injection study shows communication of lesser sac cavity with main pancreatic duct (arrows).

 

Figure 7
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  		Fig. 2C —Pancreatic pseudocyst with pancreatic ductal communication in 27-year-old woman. Follow-up CT scan shows complete resolution of pseudocyst.

 

Figure 8
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  		Fig. 3A —Biliary ascites with liver laceration in 49-year-old man. Contrast-enhanced CT scan shows right hepatic laceration (arrows) and biliary ascites in upper abdomen.

 

Figure 9
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  		Fig. 3B —Biliary ascites with liver laceration in 49-year-old man. ERCP image shows extravasation (arrow) from right intrahepatic duct (arrowhead) at site of liver laceration.

 

Figure 10
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  		Fig. 3C —Biliary ascites with liver laceration in 49-year-old man. Postprocedure CT scan with patient in oblique supine position shows catheter tip in right subphrenic space and decrease in fluid volume.

 

Figure 11
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  		Fig. 3D —Biliary ascites with liver laceration in 49-year-old man. Follow-up CT scan shows complete resolution of biliary ascites and decrease in size of liver laceration.

 

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