technetium-tc-99m-disofenin and Wounds--Stab

Scintiangiography and hepatobiliary scintigraphy were performed in 45 patients with abdominal trauma. There were 18 gunshot wounds, six stab wounds, and 21 blunt injuries. Thirty-one of 45 patients showed abnormalities (69%). There were nine bilomas (4 with leaks), three leaks without biloma, (7 total leaks), five liver hematomas, three liver infarcts, one liver abscess, four renal injuries, one post-traumatic hepatic artery aneurysm, one acute acalculus cholecystitis, and four bowel injuries including one fistula, two obstructions, and one stricture. Two of the renal injuries and the hepatic artery aneurysm were identified only during scintiangiography. Eighteen of 38 gallbladders were not visualized despite normal bowel transit and delayed views to 4 hours (47%). Fourteen of 16 gallbladders were grossly normal at surgery, one had gallstones, and one had post-traumatic acalculus cholecystitis (6%). Hepatobiliary scintiangiography showed unique characteristics of vascular and renal lesions that were not seen on routine images. Sulfur colloid had no advantage over disofenin in evaluating liver injuries in nine cases. A high percentage of nonvisualized gallbladders (47%) were noted in acutely traumatized patients, and caution is recommended in diagnosing acute cholecystitis in the face of trauma.

Topics: Abdominal Injuries; Adolescent; Adult; Aged; Biliary Fistula; Biliary Tract; Child; Cholecystitis; Extravasation of Diagnostic and Therapeutic Materials; Female; Humans; Imino Acids; Liver; Male; Middle Aged; Organometallic Compounds; Radionuclide Angiography; Technetium Tc 99m Disofenin; Wounds, Gunshot; Wounds, Nonpenetrating; Wounds, Stab

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