technetium-tc-99m-disofenin and Pancreatitis

An 8-year-old male presented with an acute abdomen. Exploration revealed bilious ascites, oedematous pancreatitis with areas of necrosis, and omentum showing patches of fat necrosis. The common bile duct and almost all of the common hepatic duct were gangrenous and had sloughed, with bile leaking from the junctional stump of the right and left hepatic ducts. The patient was managed successfully by Roux-en-Y hepaticojejunostomy. This is a rare case showing necrosis and sloughing of the extrahepatic bile ducts in acute pancreatitis.

Topics: Acute Disease; Anastomosis, Roux-en-Y; Child; Common Bile Duct; Fat Necrosis; Hepatic Duct, Common; Humans; Male; Necrosis; Omentum; Pancreatitis; Radiopharmaceuticals; Technetium Tc 99m Disofenin

Tc-99m DISIDA cholescintigraphy is a highly sensitive and specific method of evaluating cystic duct obstruction in acute cholecystitis. It has also been argued that cholescintigraphy has high sensitivity in the differential diagnosis of gallstone pancreatitis due to cystic duct obstruction following gallstone migration. The purpose of this study was to evaluate the clinical availability of cholescintigraphy in acute pancreatitis. Tc-99m DISIDA cholescintigraphy performed in 18 patients with documented acute pancreatitis, including 11 gallstone and 7 nonbiliary, were reviewed. Abnormal scans were obtained in 82% (9/11) of acute gallstone pancreatitis, while only 29% (2/7) of acute nonbiliary pancreatitis had abnormal scan. These results demonstrated a significant difference with Fisher's exact test (p < 0.05). An abnormal cholescintigraphy had a sensitivity of 82%, a specificity of 71% and an accuracy of 78% in detecting gallstone pancreatitis. Ten cases of acute gallstone pancreatitis coincided with cholecystitis (2 cases of acute and chronic, and 8 cases of chronic). Both cases of acute nonbiliary pancreatitis with abnormal scan had total parenteral nutrition over 5 days. In conclusion, abnormal cholescintigraphy in acute pancreatitis indicates gallstone origin and may coincide with cholecystitis; while, a normal cholescintigraphy largely excludes such diagnoses.

Topics: Acute Disease; Adolescent; Adult; Aged; Biliary Tract; Female; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Pancreatitis; Predictive Value of Tests; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Disofenin

Review of hepatobiliary scintigrams in patients with serologically documented pancreatitis revealed scintigraphic abnormalities in 19 of 21 studies (90%) in 19 patients. Abnormalities included duodenal loop widening (14/21 or 65%) and duodenogastric reflux (10/21 or 48%). Total biliary obstruction was seen in five studies, thereby precluding evaluation of the gastrointestinal phase in these patients. Excluding these, duodenal loop widening and duodenogastric reflux were seen in 88% and 63% of patients respectively. We evaluated three patients in whom initial scans showed obstruction, but repeat examination showed resolution of obstruction following passage of common duct stone, with duodenal loop widening and duodenogastric reflux suggestive of acute pancreatitis. Duodenal loop widening as demonstrated by hepatobiliary scintigraphy is a sign of pancreatic enlargement in acute pancreatitis, whereas duodenogastric reflux appears to be an indirect manifestation of an adjacent inflammatory process.

Topics: Acute Disease; Adult; Aged; Dilatation, Pathologic; Duodenogastric Reflux; Duodenum; Female; Humans; Imino Acids; Male; Middle Aged; Organometallic Compounds; Pancreatitis; Radionuclide Imaging; Technetium Tc 99m Disofenin

A review of 100 consecutive hepatobiliary studies revealed eight cases in which there was prominent gastric reflux of the Tc-99m diisopropyl-IDA beginning 0.5 to 2.0 hours into the procedure. Five of these individuals had pancreatitis (four acute, one chronic). Hence, pancreatitis was involved in five out of eight of the studies with marked gastric reflux. A study of discharge records showed that a total of ten of the patients in this series had pancreatitis. Since only five showed prominent gastric reflux, the incidence was 50%. Other disorders accounted for the three remaining gastric reflux cases observed in 90 patients.

Topics: Adult; Aged; Duodenogastric Reflux; Female; Gallbladder; Humans; Imino Acids; Male; Middle Aged; Pancreatitis; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Topics: Acute Disease; Cholecystitis; Humans; Imino Acids; Pancreatitis; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

The effect of etiology on findings in cholescintigraphy in patients with extrahepatic obstruction was retrospectively evaluated in 29 patients. Of 11 patients with obstruction secondary to cancer, seven (78%) of nine had complete obstruction (delayed images were not obtained in two) and nine (82%) of 11 had a moderate to severe decreases in hepatocyte clearance. Of 12 patients with obstruction secondary to cholelithiasis, only four (36%) had complete obstruction (delayed images were not obtained in one) (p less than 0.05) and all 11 had normal or only midly decreased hepatocyte clearance (p less than 0.05). All five patients with obstruction secondary to pancreatitis had mild partial obstruction and normal or mildly decreased hepatocyte clearance. One patient had partial obstruction secondary to an abscess adjacent to the common bile duct; hepatocyte clearance was mildly decreased. Cancerous and noncancerous causes of biliary tract obstruction produce significantly different findings in hepatobiliary imaging.

Topics: Abscess; Aged; Bile Duct Diseases; Cholelithiasis; Cholestasis, Extrahepatic; Humans; Imino Acids; Male; Middle Aged; Neoplasms; Pancreatitis; Radionuclide Imaging; Technetium; Technetium Tc 99m Diethyl-iminodiacetic Acid; Technetium Tc 99m Disofenin