technetium-tc-99m-disofenin and Common-Bile-Duct-Diseases

Thirty consecutive patients with intact gallbladders and biliary pain were evaluated to determine whether gallbladder ejection fraction could identify sphincter of Oddi dysfunction. The mean gallbladder ejection fraction was 45% in patients with abdominal pain and 72% in normal controls. Gallbladder ejection fractions were then correlated with endoscopically measured sphincter of Oddi pressures in patients with abdominal pain. The mean gallbladder ejection fraction was 41% in 7 patients with elevated sphincter pressures and 46% in 23 patients with normal pressures (P = NS). Thirty-six percent of patients with elevated pressures and 33% of patients with normal pressures had abnormal gallbladder ejection fractions. Gallbladder ejection fraction had a sensitivity of 33%, a specificity of 63%, and a positive predictive value of 25% for detection of elevated pressures. Regression analysis revealed a poor correlation between sphincter pressure and gallbladder ejection fraction (r2 = 0.02). These findings suggest that gallbladder ejection fraction cannot be used to diagnose sphincter of Oddi dysfunction in patients before they undergo cholecystectomy.

Topics: Abdominal Pain; Adult; Common Bile Duct Diseases; Double-Blind Method; Female; Gallbladder; Gallbladder Emptying; Humans; Imino Acids; Male; Organotechnetium Compounds; Prospective Studies; Radionuclide Imaging; Regression Analysis; Sensitivity and Specificity; Sincalide; Sphincter of Oddi; Technetium Tc 99m Disofenin

Topics: Common Bile Duct Diseases; Humans; Manometry; Morphine; Radionuclide Imaging; Reference Values; Sensitivity and Specificity; Sphincter of Oddi; Technetium Tc 99m Disofenin

Endoscopic biliary manometry is useful in the assessment of patients with types II and III sphincter of Oddi dysfunction, but it is time consuming and invasive.. To investigate the role of (99m)Tc-DISIDA scanning, with and without morphine provocation, as a non-invasive investigation in these patients compared with endoscopic biliary manometry.. A total of 34 patients with a clinical diagnosis of type II (n = 21) or III (n = 13) sphincter of Oddi dysfunction were studied. Biliary scintigraphy with 100 MBq of (99m)Tc-DISIDA was carried out with and without morphine provocation (0.04 mg/kg intravenously) and time/activity curves were compared with the results of subsequent endoscopic biliary manometry.. Eighteen (nine type II, nine type III) of the 34 (53%) patients had sphincter of Oddi basal pressures above the upper limit of normal (40 mm Hg). In the standard DISIDA scan without morphine, no significant differences were observed in time to maximal activity (Tmax) or percentage excretion at 45 or 60 minutes between those with normal and those with abnormal biliary manometry. However, following morphine provocation, median percentage excretion at 60 minutes was 4.9% in those with abnormal manometry and 28.2% in the normal manometry group (p = 0.002). Using a cut off value of 15% excretion at 60 minutes, the sensitivity for detecting elevated sphincter of Oddi basal pressure by the morphine augmented DISIDA scan was 83% and specificity was 81%. Also, 14 of the 18 patients with abnormal manometry complained of biliary-type pain after morphine infusion compared with only two of 16 patients in the normal manometry group (p = 0.001).. (99m)Tc-DISIDA with morphine provocation is a useful non-invasive investigation for types II and III sphincter of Oddi dysfunction to detect those with elevated sphincter basal pressures who may respond to endoscopic sphincterotomy.

Topics: Adult; Cohort Studies; Common Bile Duct Diseases; Humans; Infusions, Intravenous; Middle Aged; Morphine; Pressure; Radionuclide Imaging; Radiopharmaceuticals; Sphincter of Oddi; Technetium Tc 99m Disofenin

Topics: Biliary Fistula; Colonic Diseases; Common Bile Duct Diseases; Female; Humans; Imino Acids; Intestinal Fistula; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin

Topics: Common Bile Duct; Common Bile Duct Diseases; Humans; Imino Acids; Infant; Liver; Organotechnetium Compounds; Radionuclide Imaging; Rupture, Spontaneous; Technetium Tc 99m Disofenin

Endoscopic sphincterotomy has been used for the treatment of many biliary disorders, including extraction of obstructing common bile duct stones. Manometric studies of the sphincter of Oddi and the common bile duct have shown a marked decrease in biliary tract pressures after sphincterotomy. A prospective study of 12 patients with intact gallbladders using hepatobiliary imaging before and after sphincterotomy was performed to assess changes in bile dynamics. Nonfilling of the gallbladder occurred in 9 of the 12 patients after sphincterotomy, indicating significant alteration of bile flow. Such changes in bile dynamics may have serious implications in patients selected for medical dissolution of gallstones. It may also adversely affect specificity of cholescintigraphy in diagnosing acute cholecystitis.

Topics: Adult; Aged; Aged, 80 and over; Bile; Cholecystitis; Cholelithiasis; Cholestasis, Extrahepatic; Common Bile Duct; Common Bile Duct Diseases; Female; Gallbladder; Gallstones; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Pressure; Prospective Studies; Radionuclide Imaging; Sphincter of Oddi; Sphincterotomy, Endoscopic; Technetium Tc 99m Disofenin

The ideal noninvasive test of sphincter of Oddi dysfunction (SOD) does not exist and the diagnosis of patients with postcholecystectomy pain often relies on invasive procedures. In this paper we describe a scintigraphic test for SOD: the scintigraphic score. This score combines quantitative and visual criteria for interpretation of hepatobiliary scans. Twenty-six consecutive postcholecystectomy patients underwent hepatobiliary imaging, ERCP, and sphincter manometry. Twelve patients had SOD and 14 had normal sphincters determined by clinical findings, ERCP, and manometric studies. All patients with normal sphincter had scores of 0-4, while patients with SOD had values of 5-12 for a perfect sensitivity and specificity of 100%. Hepatobiliary scans scored in this fashion may become the noninvasive test of choice to screen postcholecystectomy patients with suspected SOD.

Topics: Adult; Aged; Aged, 80 and over; Cholecystectomy; Cholecystokinin; Common Bile Duct Diseases; Female; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Pain, Postoperative; Radionuclide Imaging; Retrospective Studies; Sphincter of Oddi; Technetium Tc 99m Disofenin

Radionuclide cholescintigraphy is used to help establish the diagnosis of acute cholecystitis and is thought to provide additional information regarding the patency of the biliary duct system. Nonvisualization of the extrahepatic biliary duct system and lack of excretion into the duodenum despite uptake in the liver (a positive study) is considered indicative of common bile duct obstruction. The authors retrospectively reviewed 281 hepatobiliary cholescintigrams done at Stamford Hospital from July 1, 1987 to June 30, 1989. Previous authors have demonstrated a false-positive rate of eight to 15 per cent in those cases that have a documented normal extrahepatic biliary system at operation. Of those patients explored after a common bile duct obstruction pattern depicted by cholescintigram in the authors' series, 46 per cent of patients were found to have normal extrahepatic biliary systems. Factors possibly contributing to this high false-positive rate are discussed. The utility of radionuclide hepatobiliary scans may be limited for diagnosis of biliary duct obstruction.

Topics: Cholecystitis; Cholestasis, Extrahepatic; Common Bile Duct Diseases; False Positive Reactions; Humans; Imino Acids; Organotechnetium Compounds; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Disofenin

Extracorporeal shock wave lithotripsy (ESWL) has been reported to be a safe and relatively effective non-invasive treatment for radiolucent gallbladder calculi in selected patients. Ideally, the goal of successful treatment is the passage of all fragments from the gallbladder into the intestinal tract. Biliary colic has been reported in up to 35% of treated patients, although complications such as cholecystitis, cholangitis, common bile duct obstruction, and pancreatitis are surprisingly infrequent. Cholescintigraphy is the procedure of choice in patients with biliary colic and suspected acute cholecystitis. It has proven to be more sensitive than ultrasound in detecting acute common bile duct (CBD) obstruction, since functional obstruction precedes morphologic dilatation of the CBD. This report reviews two cases of post-lithotripsy cystic and common duct obstruction and discusses the role of Tc-DISIDA scintigraphy following gallstone ESWL.

Topics: Adult; Cholelithiasis; Cholestasis; Cholestasis, Extrahepatic; Common Bile Duct Diseases; Cystic Duct; Female; Humans; Imino Acids; Lithotripsy; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin

Sphincter of Oddi (SO) dysfunction presents with vague abdominal pain and/or abnormal liver function tests, and is presumably due to SO stenosis or spasm. Clinical, laboratory, and imaging methods of diagnosis have been less than ideal. Initially, we determined normal quantitative hepatobiliary scintigraphy (QHBS) parameters both pre- and post-sincalide administration. Thirty-one "normals" were analyzed, and post-sincalide common bile duct (CBD) dynamics could be satisfactorily determined in 29 (94%) subjects. Normal values at sincalide-augmented QHBS are reported. Next, 10 patients suspected of having SO dysfunction were studied prospectively using SO manometry and QHBS. The two tests were in agreement in seven cases (4: normal CBD dynamics, 3: abnormal). In one case of advanced SO stenosis, QHBS was abnormal, but SO manometry could not be performed. In the two remaining cases, SO manometry and QHBS gave discordant results. Of greatest importance, no significant correlation existed between the quantitative parameters of these two tests. Sincalide-augmented QHBS is possible and may, in the future, be of value in the diagnosis of SO dysfunction and/or partial CBD obstruction.

Topics: Adult; Ampulla of Vater; Common Bile Duct Diseases; Female; Humans; Imino Acids; Male; Manometry; Organotechnetium Compounds; Reference Values; Sincalide; Sphincter of Oddi; Technetium Tc 99m Disofenin; Tomography, Emission-Computed

We have described the radionuclide scintigraphic and sonographic findings in two cases of neonatal choledochal cyst. These studies can be used in complementary fashion in evaluating this uncommon cause of neonatal jaundice.

Topics: Common Bile Duct Diseases; Cysts; Diagnosis, Differential; Female; Humans; Imino Acids; Infant, Newborn; Jaundice, Neonatal; Organometallic Compounds; Prenatal Diagnosis; Prognosis; Radionuclide Imaging; Technetium Tc 99m Disofenin; Ultrasonography

Sphincter of Oddi (SO) dysfunction is a recognised cause of postcholecystectomy pain, but a difficult condition to diagnose, requiring endoscopic biliary manometry (EBM) to confirm sphincter motor abnormalities. We have assessed quantitative cholescintigraphy in 10 postcholecystectomy (PC) patients with clinical and manometric evidence of SO dysfunction, 10 PC patients with non-biliary type abdominal pain and 10 asymptomatic PC volunteers acting as controls to determine its value as a non-invasive screening test. Quantitative 99mTc-DISIDA scans lasted 60 minutes, activity/time curves being created by computer analysis using the entire hepatobiliary system as region-of-interest (ROI). Scintigraphic analysis demonstrated that the time in minutes to maximum counts (Tmax) was significantly increased in the SO dysfunction group compared with the non-biliary pain group and the asymptomatic volunteers (p less than 0.001). The per cent of biliary tracer emptied was also significantly less in the SO dysfunction group than either of the other groups at both 45 minutes (p less than 0.01) and 60 minutes (p less than 0.02). We conclude that quantitative cholescintigraphy may be a valuable non-invasive screening test in clinically suspected SO dysfunction.

Topics: Adult; Aged; Ampulla of Vater; Common Bile Duct Diseases; Female; Humans; Imino Acids; Male; Manometry; Middle Aged; Organometallic Compounds; Postoperative Complications; Radionuclide Imaging; Sphincter of Oddi; Technetium; Technetium Tc 99m Disofenin

Tc-99m sulfur colloid images of the liver are frequently falsely reported as tumor or metastases in certain space occupying lesions of the liver. Whether a primary malignancy is known or not, every suspicious space-occupying lesion of the liver should be given the benefit of alternate diagnostic studies before a firm diagnosis of neoplasia is made. This is critical when the decision regarding chemotherapy has to be made. Timely intervention by other diagnostic modalities may obviate the consideration of chemotherapy in cases where there are no liver metastases. The case presented below illustrates the value of hepatobiliary tract imaging in pseudotumors of the liver.

Topics: Bile Duct Diseases; Bile Ducts, Intrahepatic; Cholecystectomy; Common Bile Duct Diseases; Cysts; Diagnosis, Differential; Diverticulum; Female; Humans; Imino Acids; Liver Neoplasms; Middle Aged; Organometallic Compounds; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

This report details an 11-year experience with 17 patients ranging from newborn to 17 years with choledochal cyst. Two distinct groups were noted: an infantile group (mean age: 3 months) with obstructive jaundice identical to biliary atresia and a late onset group (mean age: 9 years) with various combinations of pain, mass, and jaundice. Two patients had cystoduodenostomy performed and both required revision. One of six patients who had Roux-Y cystojejunostomy required revision. All seven patients who had primary cyst excision and two patients who had secondary cyst excision with Roux-Y hepaticojejunostomy have been followed prospectively and have done well. The follow-up period ranges from 1-11 years with an average of 5.8 years. Cyst excision should be performed as a primary or secondary procedure whenever feasible. The rare patients with intrahepatic ductal dilatation (Caroli's disease) are best approached by hepatic lobectomy when possible, and those with choledochocele should be treated by unroofing the cyst as indicated by the anatomy encountered.

Topics: Adolescent; Age Factors; Child; Child, Preschool; Cholestasis; Common Bile Duct Diseases; Cysts; Female; Follow-Up Studies; Humans; Imino Acids; Infant; Infant, Newborn; Male; Organometallic Compounds; Technetium Tc 99m Disofenin; Ultrasonography

Scintigraphy of the biliary system using 99mTc di-isopropyl iminodiacetic acid (DIDA) was performed in 65 subjects who had previously undergone cholecystectomy. Of the 65 subjects, 20 were free of pain and 45 had biliary-type pain both with (group I) and without (group II) features of sphincter of Oddi dysfunction. This dysfunction comprised dilatation of the bile duct, a transient rise in serum levels of liver enzymes after episodes of pain, or both abnormalities. After computer acquisition of images at intervals of 60 seconds for at least 90 minutes, time/activity curves were generated for five regions of interest: liver, common hepatic duct, common bile duct, duodenum, and background. The time at which counts in the common bile duct reached 50% of maximum (CBD T50) and the time of first entry of isotope into the duodenum (TD) were used to compare asymptomatic subjects with those with biliary-type pain. Patients in group I, but not those in group II, showed significant prolongation of CBD T50 (p less than 0.002) and TD (p less than 0.02) when compared to values in asymptomatic subjects. Six patients had a second scan at six to 12 months after endoscopic sphincterotomy and all showed a reduction in values for CBD T50 and TD. In patients with pain, a significant correlation was shown between bile duct diameter and CBD T50 (p less than 0.01) and between bile duct diameter and TD (p less than 0.02) but results from scintigraphy were independent of responses to morphine-neostigmine and motility in the sphincter of Oddi as assessed by endoscopic manometry.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Ampulla of Vater; Biliary Dyskinesia; Cholecystectomy; Common Bile Duct Diseases; Female; Humans; Imino Acids; Male; Middle Aged; Organometallic Compounds; Pain, Postoperative; Radionuclide Imaging; Sphincter of Oddi; Technetium Tc 99m Disofenin

Biliary scintigraphy and ultrasound imaging were performed in 52 patients with suspected biliary tract pathology. Results were correlated with the findings of direct cholangiography. Several new innovations in scintigraphic technique were used. The combination of ultrasound imaging and scintigraphy correctly identified biliary tract obstruction in 17 of 19 patients, 12 of whom had dilated bile ducts on ultrasonography. Intrahepatic cholestasis was correctly diagnosed in 11 of 13 patients. Accurate discrimination between intrahepatic and extrahepatic cholestasis was achieved in 28 of 32 patients (88%) with the combined studies. Scintigraphy also provided a correct diagnosis of acute cholecystitis in all 9 patients with surgically confirmed disease. Eleven additional patients with gallbladder or pancreatic disease had normal bile ducts at scintigraphy, which was confirmed with cholangiography. When combined with ultrasound imaging, modern biliary scintigraphy can (a) provide excellent discrimination between intrahepatic and extrahepatic cholestasis and (b) help determine the need for subsequent invasive diagnostic studies in selected patients.

Topics: Adult; Aged; Biliary Tract; Cholangiography; Cholecystitis; Cholestasis, Extrahepatic; Cholestasis, Intrahepatic; Common Bile Duct Diseases; Female; Gallbladder Diseases; Humans; Imino Acids; Male; Middle Aged; Pancreatic Diseases; Prospective Studies; Radionuclide Imaging; Sincalide; Technetium; Technetium Tc 99m Disofenin; Ultrasonography

Technetium-99m DISIDA imaging was employed in 400 patients to differentiate obstruction of the common bile duct from medical and other surgical causes of hyperbilirubinemia. Sequential anterior images demonstrated variable degrees of liver uptake, yet there was no evidence of intrabiliary or extrabiliary radioactivity for at least 4 hr after injection in 25 patients. Twenty-three patients were surgically documented to have complete obstruction of the common bile duct. One patient had hepatitis, and another had sickle cell crisis without bile duct obstruction. The remaining patients had either partial or no obstruction of the common bile duct. We conclude that the presence of liver uptake without evident biliary excretion by 4 hr on cholescintigraphy is highly sensitive and predictive of total obstruction of the common bile duct.

Topics: Adult; Cholestasis, Extrahepatic; Common Bile Duct Diseases; Humans; Imino Acids; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Unexplained abdominal pain after cholecystectomy has been attributed to sphincter of Oddi dysfunction, but no objective diagnostic criteria exist. Biliary excretion was quantitated by computer-assisted cholescintigraphy in 35 postcholecystectomy controls without symptoms, 9 patients with suspected sphincter of Oddi dysfunction (studied before and after sphincterotomy), and 18 patients with overt cholestasis from other causes (6 with extrahepatic obstruction and 12 with parenchymal liver disease). In patients with sphincter of Oddi dysfunction or with cholestasis, the time to attain maximal activity in the biliary system was significantly (p less than 0.05) longer, the percent of radiotracer excreted at 45, 60, and 90 min was less, and the emptying rate was slower compared with the controls. Cholecystokinin (0.02 U/kg X min) did not abolish biliary output, excluding a paradoxical response of the sphincter. After sphincterotomy, biliary activity peaked earlier and the percent excreted at 45 min increased but did not revert to normal. Relief of symptoms occurred in 8 of 9 patients. The one failure had normal emptying characteristics before sphincterotomy, and did not change after surgery. Another developed recurrent pain and a corresponding deterioration in biliary emptying on serial scans. Thus, functional obstruction at the sphincter of Oddi exists, is not due to any paradoxical response to cholecystokinin, and in the absence of overt cholestasis, can be detected by quantitative cholescintigraphy. Successful sphincterotomy may not completely restore biliary emptying to normal.

Topics: Adult; Aged; Ampulla of Vater; Cholecystectomy; Cholecystokinin; Cholestasis; Common Bile Duct Diseases; Female; Humans; Imino Acids; Male; Middle Aged; Postoperative Complications; Radionuclide Imaging; Sphincter of Oddi; Technetium; Technetium Tc 99m Disofenin

One hundred consecutive Tc-99m IDA hepatobiliary scans were reviewed revealing 14 scans (14%), that showed nonvisualization of the common bile duct (CBD), gallbladder (GB), and small bowel (SB), but good hepatic uptake of Tc-99m IDA derivative, a pattern designated by us as "the liver scan appearance." In 11 of 14 cases (79%), the diagnosis of complete CBD obstruction was confirmed by surgery, percutaneous transhepatic cholangiogram (PTC), endoscopic retrograde cholangiopancreatography (ERCP), and/or percutaneous needle biopsy (PBx). Common bile duct obstruction was suspected but not proven in the other three cases. The cholescintigraphic, ultrasound, PTC, ERCP, intraoperative cholangiogram, clinical, laboratory, and surgical findings are presented and correlated. The "liver scan-appearance" by cholescintigraphy should suggest a diagnosis of complete common bile duct obstruction; however, it does not specifically differentiate between stone or tumor as the cause of obstruction.

Topics: Cholangiography; Cholangiopancreatography, Endoscopic Retrograde; Cholestasis; Common Bile Duct; Common Bile Duct Diseases; Gallbladder; Humans; Imino Acids; Liver; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Ultrasonography

The detection, localization, and quantitation of the degree of obstruction was successfully accomplished by [99mTc]IDA scintigraphy in 13 of 14 patients with cholangiographically documented common bile duct (CBD) obstruction. Ductal dilatation was present on ultrasound examination in only seven patients. The accuracy of biliary scintigraphy was enhanced by several innovations including: (a) selection of a radiopharmaceutical with rapid hepatic uptake and excretion; (b) shorter imaging interval over longer period of time; (c) substitution of image parameter for appearance time; and (d) quantitative measurement of bile emptying parameters following cholecystokinin infusion. Scintigraphically, the partial obstruction was characterized by CBD segmental narrowing or intraluminal filling defects and bile stasis within the area and segmental ducts. The gallbladder mean (+/- s.d.) ejection fraction of 20.0 +/- 17.5%, ejection period of 6.8 +/- 1.6 min, and ejection rate of 3.1 +/- 2.6% per min following 3-min infusion of 10 ng/kg of cholecystokinin octapeptide were reduced significantly when compared to control subjects. The level of CBD obstruction correlated well with the results of cholangiography. It is concluded that quantitative biliary dynamic scintigraphy employing modern techniques can accurately detect and localize CBD obstruction.

Topics: Adult; Aged; Cholangiography; Cholestasis; Common Bile Duct Diseases; Humans; Imino Acids; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Time Factors; Ultrasonography

A choledochal cyst, observed by ultrasound at 27 wk gestation and diagnosed at 36 wk gestation, was confirmed postpartum by [99mTc]DISIDA cholescintogram. Cystic dilatation of the common bile duct was proven by surgical excision and histological verification. Ultrasonography provides in utero diagnosis of choledochal cyst, often vital for successful management. Technetium-99m DISIDA imaging is a valuable companion for defining function of the cyst.

Topics: Adolescent; Common Bile Duct Diseases; Cysts; Female; Humans; Imino Acids; Infant, Newborn; Pregnancy; Prenatal Diagnosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Ultrasonography

A 64-year-old man presented with jaundice. Hepatobiliary imaging using 99mTc-DISIDA revealed complete hepatobiliary tract obstruction with a photopenic area corresponding to a dilated gallbladder and a large photopenic region corresponding to a distended stomach as a result of gastric outlet obstruction. At surgery, carcinoma of the head of the pancreas was found to be the cause of the combined common bile duct and gastric outlet obstruction.

Topics: Cholestasis; Common Bile Duct Diseases; Humans; Imino Acids; Male; Middle Aged; Pancreatic Neoplasms; Radionuclide Imaging; Stomach Diseases; Technetium; Technetium Tc 99m Disofenin

A case is presented in which intravenous administration of glucagon, presumably by relaxation of the sphincter of Oddi, facilitated the transit of a hepatobiliary radiopharmaceutical from the gallbladder into the bowel. This approach is likely more feasible than food intake and at least theoretically safer than cholecystokinin administration. Further studies are needed to assess the actual usefulness of this intervention.

Topics: Adult; Common Bile Duct Diseases; Female; Gallbladder; Glucagon; Humans; Imino Acids; Radionuclide Imaging; Sphincter of Oddi; Technetium; Technetium Tc 99m Disofenin

Topics: Child, Preschool; Common Bile Duct Diseases; Cysts; Diagnosis, Differential; Gallbladder; Humans; Imino Acids; Liver; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Cholescintigraphy with Tc-99m iminodiacetic acid (IDA) agents has proved to be a convenient, non-invasive method for evaluating patients with suspected cholecystitis. (1,2) We recently examined two patients who were being evaluated for abdominal pain. The etiology of the two abnormal cholescintigrams was later proven to be due to nonhepatobiliary pathology.

Topics: Abdomen; Adult; Ampulla of Vater; Biliary Tract; Common Bile Duct Diseases; Duodenal Ulcer; Humans; Imino Acids; Male; Middle Aged; Morphine; Pain; Radionuclide Imaging; Spasm; Sphincter of Oddi; Technetium; Technetium Tc 99m Disofenin

This report deals with the diagnosis of perforation of the common bile duct into the lesser sac by HIDA cholescintigraphy. The first hour images after injection were suggestive of biliary obstruction. Subsequent images demonstrated unusual accumulations of the activity into the lesser sac and retroperitoneal potential spaces. Careful correlation between scintigraphic and surgical findings were undertaken. The case is reported to demonstrate the scintigraphic findings in choledochal perforation and to stress the importance of carrying out late images when the initial ones are abnormal.

Topics: Aged; Bile; Common Bile Duct Diseases; Gallstones; Humans; Imino Acids; Male; Peritoneal Cavity; Radionuclide Imaging; Retroperitoneal Space; Technetium; Technetium Tc 99m Disofenin; Time Factors

Topics: Ascites; Bile; Common Bile Duct Diseases; Cysts; Female; Humans; Imino Acids; Infant; Peritonitis; Radionuclide Imaging; Rupture, Spontaneous; Technetium; Technetium Tc 99m Disofenin

Topics: Biliary Tract; Biliary Tract Surgical Procedures; Cholecystitis; Cholestasis; Common Bile Duct Diseases; Edema; Gallbladder; Humans; Imino Acids; Intestine, Small; Liver; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin