HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) CME Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Thurley, P. D. Articles by Dhingsa, R. Search for Related Content PubMed PubMed Citation Articles by Thurley, P. D. Articles by Dhingsa, R. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?

Laparoscopic Cholecystectomy: Postoperative Imaging

¹ Both authors: Department of Radiology, Nottingham University Hospitals, Queens Medical Centre, Derby Rd., Nottingham, NG7 2UH, United Kingdom.

View larger version (151K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Normal appearances after cholecystectomy. CT scan of 53-year-old woman 2 days after laparoscopic cholecystectomy shows collection measuring 21 HU (consistent with fluid) is present within gallbladder fossa (arrow) adjacent to cholecystectomy clip. This is commonly seen after uncomplicated laparoscopic cholecystectomy.

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Normal appearances after cholecystectomy. CT scan of 62-year-old woman with abdominal pain and pyrexia after laparoscopic cholecystectomy shows mixed gas–fluid attenuation in gallbladder fossa, consistent with Surgicel (oxidized regenerated cellulose, Johnson & Johnson Ethicon) (arrow). Review of surgical notes confirmed that Surgicel had been used in gallbladder bed. Patient's symptoms settled without intervention.

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —T2-weighted MR image of 16-year-old girl with abdominal pain, elevated inflammatory markers, and pyrexia 2 months after laparoscopic cholecystectomy. Note fluid collection in gallbladder fossa (arrowhead); area of signal void anterior (arrow) to collection represents air. Patient was treated for infected collection with antibiotics, and MRI 6 months later showed resolution of changes.

View larger version (151K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Bile duct injuries. 42-year-old woman with abdominal pain, pyrexia, and leukocytosis 10 days after laparoscopic cholecystectomy. CT scan (A) shows Surgicel (oxidized regenerated cellulose, Johnson & Johnson Ethicon) in gallbladder fossa (thin arrow, A) and small fluid collection adjacent to tip of liver (thick arrow, A). Patient underwent laparotomy, which showed leak from common bile duct (CBD), which was sutured. Patient remained unwell and underwent ERCP (B), which showed persistent leak from damaged CBD (arrow, B). Leak resolved after endoscopic placement of a stent.

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Bile duct injuries. 42-year-old woman with abdominal pain, pyrexia, and leukocytosis 10 days after laparoscopic cholecystectomy. CT scan (A) shows Surgicel (oxidized regenerated cellulose, Johnson & Johnson Ethicon) in gallbladder fossa (thin arrow, A) and small fluid collection adjacent to tip of liver (thick arrow, A). Patient underwent laparotomy, which showed leak from common bile duct (CBD), which was sutured. Patient remained unwell and underwent ERCP (B), which showed persistent leak from damaged CBD (arrow, B). Leak resolved after endoscopic placement of a stent.

View larger version (151K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —Bile duct injuries. Image from ERCP in 31-year-old woman. Clips have been placed across CBD (thin arrow), and free contrast material (thick arrow) is visible because of duct injury. Patient was treated with hepatojejunostomy.

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —56-year-old woman with abdominal pain following laparoscopic cholecystectomy. CT scan shows multiple large intraabdominal fluid collections (arrows) that contained bile when drained.

View larger version (147K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —56-year-old woman with abdominal pain following laparoscopic cholecystectomy. Subsequent ERCP shows leak from cystic duct stump (arrow).

View larger version (145K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —56-year-old woman with abdominal pain following laparoscopic cholecystectomy. Subsequent ERCP shows stent that has been deployed endoscopically in common bile duct across origin of cystic duct.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —56-year-old woman with abdominal pain 3 months after laparoscopic cholecystectomy. Axial CT image shows low-attenuation change in pancreas (arrow) and peripancreatic fluid, in keeping with pancreatitis.

View larger version (152K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —56-year-old woman with abdominal pain 3 months after laparoscopic cholecystectomy. MRCP shows filling defects in common bile duct (CBD) (arrows) and normal-caliber pancreatic duct (arrowheads).

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —56-year-old woman with abdominal pain 3 months after laparoscopic cholecystectomy. ERCP confirms retained gallstones in CBD (arrow).

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —72-year-old man with abdominal pain and abnormal liver biochemistry following laparoscopic cholecystectomy. Postoperative CT scan shows dilated ducts in left lobe of liver.

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —72-year-old man with abdominal pain and abnormal liver biochemistry following laparoscopic cholecystectomy. ERCP shows filling defects in common bile duct that are consistent with retained stones. Gallstones were subsequently removed endoscopically.

View larger version (151K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7 —Intraoperative cholangiography image of 66-year-old woman shows stone at distal common bile duct (arrow) and bile duct dilatation.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8A —71-year-old man with history of laparoscopic cholecystectomy. Sonogram shows dropped gallstone in subdiaphragmatic space (arrow).

View larger version (80K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8B —71-year-old man with history of laparoscopic cholecystectomy. Reformatted oblique coronal CT image shows subdiaphragmatic gallstone (arrow).

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9A —41-year-old woman 3 weeks after laparoscopic cholecystectomy. Patient presented with abdominal pain. (Courtesy of R. O'Neill, Nottingham University Hospitals.) CT scans show area of hyperdensity representing contrast material (arrow) and associated area of mixed attenuation suspected to be a hematoma. This raised possibility of hemorrhage from a pseudoaneurysm. Note adjacent surgical clip (arrowhead).

View larger version (96K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9B —41-year-old woman 3 weeks after laparoscopic cholecystectomy. Patient presented with abdominal pain. (Courtesy of R. O'Neill, Nottingham University Hospitals.) CT scans show area of hyperdensity representing contrast material (arrow) and associated area of mixed attenuation suspected to be a hematoma. This raised possibility of hemorrhage from a pseudoaneurysm. Note adjacent surgical clip (arrowhead).

View larger version (130K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9C —41-year-old woman 3 weeks after laparoscopic cholecystectomy. Patient presented with abdominal pain. (Courtesy of R. O'Neill, Nottingham University Hospitals.) Diagnosis of hepatic artery pseudoaneurysm (arrow, D) was confirmed with selective angiography of celiac axis. Note adjacent surgical clip (arrowhead, D).

View larger version (140K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9D —41-year-old woman 3 weeks after laparoscopic cholecystectomy. Patient presented with abdominal pain. (Courtesy of R. O'Neill, Nottingham University Hospitals.) Diagnosis of hepatic artery pseudoaneurysm (arrow, D) was confirmed with selective angiography of celiac axis. Note adjacent surgical clip (arrowhead, D).

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10 —Axial CT image of 61-year-old woman with clinical features of small-bowel obstruction 3 days after cholecystectomy. Note fluid-filled loops of small bowel (arrowhead) proximal to hernia (arrow) at site of laparoscopy port.

CiteULike

Complore

Connotea

Del.icio.us

Digg

Reddit

Technorati