*18-year-old female with vomiting and abdominal pain after cholecystectomy.
What is the most likely diagnosis?
1. Intra-abdominal abscess
2. Intestinal perforation
3. Intra-abdominal hemorrhage
4. Bile leakage
Answer
Answer: Bile leakage secondary to cholecystectomy
Case Discussion:
T2w coronal image shows loculated fluid collection in the inferior to the left lobe of the liver and paracolic gutters. Pre- and postcontrast (Primovist) images demonstrate the fluid collection is enhanced by the contrast agent (arrows) indicating bile leakage.
Bile leakage is a rare complication of cholecystectomy. The bile leakage can originate from the gallbladder bed, the cystic duct or infrequently from injury to a major bile duct (1). Gadoxetate disodium (also known by the tradenames Primovist in Europe and Eovist in North America) is a hepatospecific paramagnetic gadolinium based contrast agent, used entirely in MRI liver imaging (2). Contrast enhanced MR cholangiography is used to evaluate bile leak, suspected gallbladder obstruction, hepatojejunostomy. Following an early dynamic phase in a transverse plane, the scan was repeated in the transverse and coronal planes at 5, 10, 20, 30, 60 min for detection of the bile leakage (3).
References:
1. Cushieri A, Dubois F, Mouiel J, et al. The European experience with laparoscopic cholecystectomy.Am J Surg. 1991;161:385–7.
2. Van Beers BE, Pastor CM, Hussain HK. Primovist, Eovist: what to expect?. J. Hepatol. 2012;57: 421-9.
3. Kantarcı M, Pirimoglu B, Karabulut N, Bayraktutan U, Ogul H, Ozturk G, Aydinli B, Kizrak Y, Eren S, Yilmaz S. Non-invasive detection of biliary leaks using Gd-EOB-DTPA-enhanced MR cholangiography: comparison with T2-weighted MR cholangiography. Eur Radiol. 2013 Oct;23(10):2713-22.