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Radiological Reasoning: Postoperative Hemorrhage After Open Cholecystectomy and Common Bile Duct Exploration

¹ Department of Vascular and Interventional Radiology, University of Chicago Hospitals, MC-2026, 5841 S Maryland Ave., Chicago, IL 60637.
² Department of Radiology, Weiss Memorial Hospital, Chicago, IL.

View larger version (103K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —74-year-old man with hemorrhage after open cholecystectomy and common bile duct exploration. Unenhanced CT scan obtained after open cholecystectomy because of suspicion of intraabdominal bleeding or hemobilia shows 6-cm high-density fluid collection (asterisk) in gallbladder fossa that is suspicious for a hematoma or area of contrast extravasation that was occult or delayed on prior T-tube cholangiogram.

View larger version (148K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —74-year-old man with hemorrhage after open cholecystectomy and common bile duct exploration. Selective hepatic arteriograms. Early arterial phase (B) shows patent hepatic arteries. Mid arterial phase (C) shows cystic artery stump (arrow,C) and takeoff from proximal right hepatic artery. Delayed phase (D) shows 1- to 2-mm focal puddling (arrow, D) of contrast material from cystic artery, suspicious for site of active bleeding.

View larger version (157K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —74-year-old man with hemorrhage after open cholecystectomy and common bile duct exploration. Selective hepatic arteriograms. Early arterial phase (B) shows patent hepatic arteries. Mid arterial phase (C) shows cystic artery stump (arrow,C) and takeoff from proximal right hepatic artery. Delayed phase (D) shows 1- to 2-mm focal puddling (arrow, D) of contrast material from cystic artery, suspicious for site of active bleeding.

View larger version (151K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —74-year-old man with hemorrhage after open cholecystectomy and common bile duct exploration. Selective hepatic arteriograms. Early arterial phase (B) shows patent hepatic arteries. Mid arterial phase (C) shows cystic artery stump (arrow,C) and takeoff from proximal right hepatic artery. Delayed phase (D) shows 1- to 2-mm focal puddling (arrow, D) of contrast material from cystic artery, suspicious for site of active bleeding.

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1E —74-year-old man with hemorrhage after open cholecystectomy and common bile duct exploration. Cystic arteriogram shows large area of contrast extravasation (arrow) into gallbladder fossa (arrowheads) that is consistent with active bleeding.

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1F —74-year-old man with hemorrhage after open cholecystectomy and common bile duct exploration. Postembolization hepatic angiogram shows cessation of active bleeding after 2-mm microcoils (arrow) were deployed. Flow is preserved to right hepatic artery.

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