technetium-tc-99m-disofenin and Fistula

Biliary vomiting developed 16 mo after resection of adenocarcinoma of the esophagus in a patient with a complex postoperative course. A biliary scan revealed an outline of the pericardium, suggesting a fistula. The potential role of radionuclide imaging in this rare and potentially fatal complication is discussed.

Topics: Biliary Tract; Fistula; Humans; Imino Acids; Liver; Male; Middle Aged; Organotechnetium Compounds; Pericardium; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Postoperative hepatobiliary scintigraphy is recommended in selected cases of hepatic trauma to evaluate the integrity and patency of the biliary system. We present a patient with a traumatic hematoma that eventuated in a biloma with spontaneous biliary-cutaneous fistula. Repeat study demonstrated biliary obstruction at the canalicular level, which by more invasive imaging was found secondary to total obstruction of the common hepatic duct. The precise anatomical level and cause of his obstruction were defined by the findings of endoscopic retrograde cannulation of the pancreas, percutaneous transhepatic cholangiography, and surgery.

Topics: Adult; Biliary Fistula; Biliary Tract; Cholangiography; Cholangiopancreatography, Endoscopic Retrograde; Cholestasis; Fistula; Humans; Imino Acids; Liver; Male; Postoperative Complications; Radionuclide Imaging; Skin Diseases; Technetium; Technetium Tc 99m Disofenin; Wounds, Stab