technetium-tc-99m-lidofenin and Postoperative-Complications

There have been evolutionary changes in the management of pathological conditions of the hepatobiliary system over recent years, particularly with an increasing emphasis on modern hepatobiliary surgical techniques. Concurrent advances have occurred in imaging technology and availability, leading to a greater use of ultrasound, multidetector computed tomography (CT), and magnetic resonance imaging (MRI) in the primary evaluation of hepatobiliary disease. Radionuclide imaging using technetium(99m) (Tc(99m)) hepatobiliary iminodiacetic acid (HIDA) derivatives is an established technique that complements morphological imaging, providing valuable functional information in both pre- and postoperative evaluation of patients with suspected or known hepatobiliary disease. This review discusses the current clinical indications for Tc(99m) HIDA scintigraphy using clinical cases to demonstrate how this technique continues to play a valuable diagnostic role in the assessment of the functional integrity of the hepatobiliary system.

Topics: Biliary Tract Diseases; Chelating Agents; Humans; Liver Diseases; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Lidofenin

Biliary microlithiasis is an uncommon but recognized cause of upper abdominal pain, cholecystitis, cholangitis, and pancreatitis in adults. Gallstones smaller than 3 mm may not be seen on transabdominal ultrasound and may only be seen on endoscopic ultrasound. This condition is poorly described in children. The aim of this study is to review the results of laparoscopic cholecystectomy to treat biliary microlithiasis in a pediatric case series.. We performed a retrospective case review of children with biliary microlithiasis who were treated with laparoscopic cholecystectomy.. Three children were diagnosed with biliary microlithiasis. Two patients had recurrent right upper quadrant pain and nausea. A third patient had midepigastric pain and idiopathic pancreatitis. All 3 had a normal gallbladder on transabdominal ultrasound. Additional imaging with hepatobiliary scan, computed tomography, and magnetic resonance cholangiopancreatography revealed no biliary source for symptoms. Endoscopic ultrasound was performed on all 3 children, demonstrating microlithiasis of the gallbladder. Each child had a laparoscopic cholecystectomy with intraoperative cholangiogram. No abnormalities were seen on intraoperative cholangiogram. All 3 children had alleviation of pain and improvement of symptoms in postoperative follow-up.. Children with biliary microlithiasis and associated clinical symptoms can be successfully treated with laparoscopic cholecystectomy. Endoscopic ultrasound should be considered in the evaluation of the child with clinical biliary symptoms and a negative transabdominal ultrasound result.

Topics: Adolescent; Age of Onset; Antibiotic Prophylaxis; Ceftriaxone; Child; Cholagogues and Choleretics; Cholangiography; Cholangiopancreatography, Magnetic Resonance; Cholecystectomy, Laparoscopic; Cholelithiasis; Combined Modality Therapy; Comorbidity; Endosonography; False Negative Reactions; Female; Follow-Up Studies; Humans; Male; Neurosurgical Procedures; Pancreatitis; Postoperative Complications; Radiography, Interventional; Retrospective Studies; Technetium Tc 99m Lidofenin; Tomography, X-Ray Computed; Ursodeoxycholic Acid

Hepaticojejunostomy (HJ) is a common operation used to by-pass extrahepatic biliary obstructions and to establish biliary-enteric continuity after resections for benign and malignant diseases. Little is known about the effect of this procedure on hepatobiliary physiology. The aim of the present study was to investigate in a swine model the changes in biliary dynamics, bile composition, and hepatic histology induced by Roux-Y HJ. Twenty-four swine (57 (47 to 76) kg) underwent cholecystectomy, with HJ (Group I; n = 12) or without any biliodigestive anastomosis (Group II, n = 12), and were followed up for 6 or 12 mo by repeated weight scaling, blood, serum, and bile analysis, (99m)Technetium (Tc), diethyliminodiacetic acid (HIDA) dynamic biligraphy, and histological analysis. During follow-up, HJ was associated with less weight gain, colonization of the bile duct with aerobic bacteria Escherichia coli dominating (in 75% of the animals), a shortened hilum-intestine transit time but reduced liver clearance in dynamic biligraphy, and fibrous periportal changes in liver histology (in 50% of the animals). We conclude that during 1 y follow-up HJ with no anastomotic stricture formation is associated with improved extrahepatic bile drainage, but with ascending contamination of bile ducts with bacteria, which might be involved with the fibrous periportal changes in the liver resulting in diminished excretion of Tc-HIDA from the hepatocytes into the bile. The clinical significance of these changes, and the reduced weight gain observed is a topic of further investigations.

Topics: Anastomosis, Roux-en-Y; Animals; Bile; Cholecystectomy; Gallbladder; Hepatic Duct, Common; Jejunum; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Sus scrofa; Technetium Tc 99m Lidofenin; Weight Gain

In two patients who had laparoscopic cholecystectomy, the postoperative course was complicated by continuous bilious drainage from the surgical drain in one and by jaundice in the other. In both patients, the findings of 99mTc-N-substituted-2,6-dimethylphenyl carbamoylethyl iminodiacetic acid (HIDA) scanning were interpreted as clearly demonstrating a significant bile leak in one and the complete absence of bile passage from the liver to the intestines in the other. These findings could result from either spontaneous closure of the bile leak or false-positive HIDA scans. Subsequent endoscopic retrograde cholangiopancreatography (ERCP) showed the common bile duct and the cystic duct to be normal, without any evidence of bile leakage or any problem with drainage to the intestines. In all patients who have a positive 99mTc-HIDA scan, ERCP should be performed before deciding on further surgical intervention.

Topics: Adult; Bile; Cholangiopancreatography, Endoscopic Retrograde; Cholecystectomy, Laparoscopic; Female; Humans; Male; Middle Aged; Postoperative Complications; Radiopharmaceuticals; Technetium Tc 99m Lidofenin

Tc-99m HIDA scintigraphy in a patient with septic complications after partial resection of the esophagus and gastroesophagostomy demonstrated a free bile leak through the anastomosis to the thoracic drains. Concomitant attempts to verify this with dye ingestion (methylene blue) and x-ray examinations were negative.

Topics: Anastomosis, Surgical; Biliary Tract; Carcinoma, Squamous Cell; Esophageal Neoplasms; Esophagogastric Junction; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Postoperative Complications; Radiography; Radionuclide Imaging; Technetium Tc 99m Lidofenin

Postoperative reflux gastritis in persons who were operated on for peptic ulcer occurs much more frequently after resection of the stomach (68.6%) than after organ-preserving operations on the stomach (39.4%). The incidence of reflux gastritis after gastric resection depends on the type of gastroenteroanastomosis. It is encountered much less frequently after Roux' operation (9.2%). The pronounced character and frequency of reflux gastritis after organ-preserving operations on the stomach are determined by the type of stomach-draining operations, the localization of the ulcer before the operation, whether in the stomach or the duodenum, the existence of duodenogastric reflux (DGR) before the operation. Measures for the prevention of postoperative reflux gastritis in the management of peptic ulcer are as follows: (a) wide introduction of organ-preserving operations, preferably SPV by itself or in combination with duodenoplasty; (b) formation of Roux' gastroenteroanastomosis when resection of the stomach is indicated. Reflux gastritis must be treated by nonoperative methods, including medicinal, dietetic, and spa therapy. Surgery is indicated in reflux gastritis combined with other diseases of a stomach which had been operated on, for which an operation is necessary, and in occasional cases of erosive reflux gastritis.

Topics: Aluminum Hydroxide; Anastomosis, Roux-en-Y; Antacids; Balneology; Benzocaine; Combined Modality Therapy; Drug Combinations; Duodenogastric Reflux; Duodenum; Gastrectomy; Gastritis; Gastroenterostomy; Humans; Imino Acids; Incidence; Magnesium Hydroxide; Metoclopramide; Organotechnetium Compounds; Peptic Ulcer; Postoperative Complications; Stomach; Technetium Tc 99m Lidofenin; Vagotomy, Proximal Gastric

Hepatobiliary scintigraphy with analogs of iminodiacetic acid (IDA) has become one of the primary tools in the diagnosis of biliary tract diseases, especially in the evaluation of surgical results and detection of complications that may arise from biliary operative procedures. We have performed cholescintigraphy in 19 patients. Of them, 9 underwent choledochojejunostomy with Roux-en-Y reconstruction for recurrent choledocholithiasis, 1 underwent right hepatic resection for metastasis extirpation, 8 were post cholecystectomy patients effected with upper abdominal pain located either in the epigastric region or right upper quadrant referable to post cholecystectomy syndrome and the last exhibited chronic pancreatitis ans suspicious sphincter of Oddi stenosis. The scintigraphy data were compared with the information yielded by sonography, intravenous cholangiogram (IVC) and, when possible, by endoscopic retrograde cholangiopancreatography (ERCP). Scans were considered pathologic when one or more of the following criteria were present: a) delayed biliary to bowel transit (greater than 1 hr), b) abnormal time-activity dynamic, c) no intestinal activity (obstruction), d) apparent ductal dilatation. In the group of biliary-enteric anastomosed patients, cholescintigraphic findings have shown 3 normal cases, 3 cases of biliary-intestinal obstruction confirmed by surgery, and 3 with abnormal activity retention in the jejunum loop due, in 2 patients, to hypokinesia since the quick emptying following the administration of 10 mg i.v. of metoclopramide, while in the other one, the surgery reexploration exhibited the presence of adhesions producing intestinal stricture. in the last patient of this group, the cholescintigraphy was performed to detect possible biliary leaks. In the post cholecystectomy patients, the cholescintigraphy exhibited in 3 cases dilated common duct with functional patency since the normal biliary-bowel transit time (less than 1 hr); this was confirmed by sonogram and IVC.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Biliary Tract; Biliary Tract Surgical Procedures; Cholecystectomy; Female; Follow-Up Studies; Gallstones; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Postoperative Complications; Radionuclide Imaging; Recurrence; Technetium Tc 99m Lidofenin

To assess the role of Tc-99m IDA cholescintigraphy in diagnosing bile leakage and bile obstruction after laparoscopic cholecystectomy, 51 studies were performed in 51 patients on the first postoperative day. Two different radioactive bile acid analogs were used, Tc-99m HIDA and Tc-99m trimethylbromo IDA. Scintigraphic findings were correlated with the clinical conditions. Results of seven out of 51 cholescintigrams were abnormal, showing accumulations of activity in the right paracolic gutter. Of these seven patients, only three had clinical symptoms consisting of more than normal postoperative abdominal pain and peritoneal irritation. The other four patients had minimal abnormal accumulation in the right paracolic gutter and showed no clinical signs postoperatively. Complete common bile duct obstruction or other bile duct-related complications, except for bile leakage, were not observed. Cholescintigraphy is feasible for the early detection of bile leakage and bile flow obstruction after laparoscopic cholecystectomy in patients with increased postoperative abdominal discomfort.

Topics: Bile Duct Diseases; Cholecystectomy; Cholestasis; Humans; Imino Acids; Laparoscopy; Organotechnetium Compounds; Postoperative Complications; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Lidofenin

The Tc-99m HIDA scan is a valuable study after liver transplantation, associated with other image techniques. We have used this technique as a reliable and objective diagnostic method for biliary fistula after removal of the T-tube in 5 liver transplantation patients with pain after T-tube removal. All five patients who developed fistula not only were diagnosed immediately but, furthermore, the surgical technique was indicated by the gammagraphic study. After this experience, we propose to remove the T-tube during the Tc-99 HIDA scan.

Topics: Biliary Fistula; Drainage; Gamma Cameras; Humans; Imino Acids; Liver Transplantation; Organotechnetium Compounds; Postoperative Complications; Radionuclide Imaging; Technetium Tc 99m Lidofenin

Ultrasound and 99Tcm-HIDA scanning were compared in the evaluation of postoperative biliary leakage after cholecystectomy. In thirty-five patients the abdomen was scanned and imaged on the first postoperative day. Isotope activity in the right upper quadrant and whole abdomen was determined to obtain an activity ratio. Ultrasonography was also performed. Accumulation of 99Tcm-HIDA in the gall bladder bed or over the surface of the liver was regarded as evidence of a bile leak. Eleven patients had abnormal 99Tcm-HIDA images (activity ratios of 0.20-0.77, mean 0.51) but only five patients had loculated fluid on ultrasound scanning. Twenty-four patients had normal 99Tcm-HIDA images (activity ratios of 0-0.17, mean 0.21), but fifteen of these had loculated fluid on ultrasound scanning. We conclude that bile leaks occur in 30% of patients following cholecystectomy and are best detected by 99Tcm scanning rather than ultrasonography.

Topics: Adult; Aged; Aged, 80 and over; Bile; Cholecystectomy; Drainage; Female; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Postoperative Complications; Radionuclide Imaging; Technetium Tc 99m Lidofenin; Ultrasonography

In an experimental study on 65 rats the influence of different Roux-Y biliary anastomoses on the enterohepatic bile acid circulation was investigated. Long (10 cm) and short (3 cm) isoperistaltic and long (10 cm) anisoperistaltic Roux-Y loops were studied and compared to sham-operated controls. 75-SeHCAT a y-labeled synthetic bile acid was used for assessment of enterohepatic circulation. Hepatic excretion and enteric bile flow was investigated by 99m-Tc-HIDA. Intestinal transit time was evaluated by 51-Cr-EDTA an inert marker of intestinal contents. Animals with biliary anastomoses showed an increased retention of the synthetic bile acid 75-SeHCAT compared to the controls. Highest retention values were found in animals with anisoperistaltic loops (t1/2 = 98.6 h). Isoperistaltic loops showed uniform values independently of the length of the Roux-limb (t1/2 = 59.8 h resp. 59.3 h). Differences to the controls (t1/2 = 42.6 h) were highly significant (p less than 0.001). In the 99m-Tc-HIDA hepatic excretion into the connected small bowel was normal in all groups. But in rats with biliary anastomoses a marked stasis of the 99m-Tc-HIDA in the Roux-Y loop was apparent. Bowel transit time tested by 51-Cr-EDTA showed comparable results in all groups without significant differences. The results demonstrate an increased bile acid retention in Roux-Y biliary anastomoses. An alteration of the enterohepatic circulation due to stasis in the Roux-Y limb seems to be the underlying mechanism.

Topics: Anastomosis, Roux-en-Y; Animals; Bile Acids and Salts; Choledochostomy; Chromium Radioisotopes; Edetic Acid; Enterohepatic Circulation; Imino Acids; Male; Organotechnetium Compounds; Peristalsis; Postoperative Complications; Radionuclide Imaging; Rats; Taurocholic Acid; Technetium Tc 99m Lidofenin

One hundred and seven patients with postoperative reflux gastritis treated by Roux-en-Y biliary diversion were reviewed. Three patients died in the postoperative period, and 16 others have since died; cardiorespiratory disease was the most frequent cause of death. Seventy-nine patients were interviewed at a median of 5.5 years (range 0.5-26 years) following Roux-en-Y diversion. At review, a satisfactory result by modified Visick grading was present in 47 per cent of patients. Bilious vomiting (P less than 0.001), food vomiting (P less than 0.01), the severity of upper abdominal pain (P less than 0.001) and heartburn (P less than 0.025) were significantly improved by Roux-en-Y diversion. Weight, haemoglobin levels and employment status were not significantly altered by the procedure. Outcome was related to the surgery preceding Roux-en-Y diversion with significantly better results after partial gastrectomy compared with truncal vagotomy and drainage (P less than 0.01), cholecystectomy (P less than 0.05), or combinations of these procedures (P less than 0.01). Outcome was not predicted by sex, preoperative symptoms, smoking status, consultant surgeon, length of Roux-en-Y or 99Tc-Sn-2,6-di-ethylacetanilidoiminodiacetate (HIDA) scanning results.

Topics: Adult; Aged; Anastomosis, Roux-en-Y; Female; Follow-Up Studies; Gastritis; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Postoperative Complications; Radionuclide Imaging; Technetium Tc 99m Lidofenin; Vomiting

Drains after cholecystectomy are used commonly to avoid biliary leaks and subsequent peritonitis. Thirty-five patients who had had cholecystectomy without drainage underwent 99mTc-labelled dimethylphenylcarbamoylmethyliminodiacetic acid (HIDA) and ultrasound scans the morning after surgery. Biliary leaks detected by positive HIDA scans occurred in 11 patients. Subhepatic fluid collections were seen on 20 ultrasound scans. There was no relation between biliary leaks and subhepatic collections. Many of the collections were not seen on the HIDA scan, suggesting that they contained blood and not bile. Many of the patients with bile leaks showed no fluid collection. Clinical complications were few and evenly distributed between those with positive and negative scans. We conclude that bile leaks are not an occasional event but occur after 31 per cent of undrained cholecystectomies and that these bile leaks remain clinically unimportant.

Topics: Bile; Cholecystectomy; Drainage; Female; Gallbladder; Humans; Imino Acids; Male; Organotechnetium Compounds; Postoperative Complications; Radionuclide Imaging; Technetium Tc 99m Lidofenin; Ultrasonics

Functional-scintigraphic examinations were conducted to establish liver functionality and kinetics of extrahepatic bile flow, using 99mTc-Rotop-Ehida, in 25 patients with bilio-biliary or bilio-digestive anastomosis calibrated by ring drainage. Checks were made with indwelling drainage in place or after its removal. Liver damage was detectable in 80 per cent of all probands. The method based on nuclear medicine has proved to be more suitable for quantitative functionality assessment than clinical examinations and enzyme activity tests. With ring drainage in place, it may provide useful information complementary to X-ray presentation of bile duct conditions. After removal of ring drainage, it should be preferred to invasive methods of examination.

Topics: Anastomosis, Surgical; Common Bile Duct; Drainage; Humans; Iatrogenic Disease; Imino Acids; Liver Cirrhosis, Biliary; Liver Function Tests; Organometallic Compounds; Postoperative Complications; Radionuclide Imaging; Technetium Tc 99m Lidofenin

Serial HIDA scanning was performed on a patient following liver transplantation. During the patient's course he developed biliary obstruction that manifested as a photopenic region in the liver, on the HIDA scan which filled in on the delayed views. The patient subsequently developed a region in the superior portion of the right lobe of the liver that did not fill in with activity on delayed views. The patient was experiencing low-grade fevers and was clinically believed to have either an abscess or an episode of rejection. A gallium scan was performed revealing a photopenic defect in the same region as the HIDA. Because of the clinical suspicion of abscess, a percutaneous transhepatic drainage study was performed, revealing a large abscess cavity in the suspect area within the liver. Following the drainage the patient did well. This case illustrates the usefulness of serial HIDA scanning in patients who have received liver transplants. It also is important to note that the gallium scan was negative in this hepatic abscess. In the authors' opinions, the finding of an intrahepatic fluid collection in a septic patient that does not fill with activity on the HIDA study, should be considered the source of the infection, until proven otherwise, and should be drained regardless of the findings of other studies.

Topics: Child, Preschool; Drainage; Female; Gallium Radioisotopes; Humans; Imino Acids; Liver Abscess; Liver Transplantation; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Ultrasonography

Serial HIDA scanning has proven to be a valuable tool in the postoperative management of liver transplant patients. Previous reports have documented its efficacy in detecting biliary leakage, abscess, and rejection. We have also found HIDA scanning to be a sensitive method for detecting early hepatic infarction before ultrasonographic changes occur. Two cases are presented to demonstrate the characteristic findings seen with hepatic infarctions.

Topics: Child; Female; Humans; Imino Acids; Infant; Infarction; Liver; Liver Transplantation; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

Topics: Adult; Aged; Aged, 80 and over; Ampulla of Vater; Biliary Tract; Common Bile Duct; Female; Humans; Imino Acids; Jejunum; Liver; Male; Middle Aged; Organometallic Compounds; Postoperative Complications; Radionuclide Imaging; Sphincter of Oddi; Technetium Tc 99m Lidofenin

Hepatobiliary imaging after Whipple's operation provides information regarding the flow of bile. In the case presented there was jejunogastric bile reflux. This demonstrated the incompetence of the side to side jejunojejunostomy, which was surgically recommended to avoid bile reflux to the stomach. Jejunogastric bile reflux explains the patient's complaint of dyspepsia and occasional bilious vomiting in this case.

Topics: Bile Reflux; Biliary Tract; Duodenum; Humans; Imino Acids; Male; Middle Aged; Pancreatectomy; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

Topics: Bile Ducts; Duodenum; Gallbladder; Humans; Imino Acids; Jejunum; Liver; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

Topics: Bile Reflux; Biliary Tract Diseases; Gastrectomy; Humans; Imino Acids; Postoperative Complications; Radionuclide Imaging; Stomach; Technetium; Technetium Tc 99m Lidofenin

Topics: Adult; Aged; Bile Reflux; Biopsy; Endoscopy; Female; Gastrectomy; Gastric Juice; Humans; Hydrogen-Ion Concentration; Imino Acids; Male; Mass Screening; Middle Aged; Postoperative Complications; Precancerous Conditions; Radionuclide Imaging; Risk; Stomach Neoplasms; Technetium; Technetium Tc 99m Lidofenin

Intestinal fistulae have been outlined using the delayed phase of Tc-99m labelled HIDA. The technique involved is simple, safe and easily reproducible. This method has advantages over conventional radiography particularly for the leaking duodenal stump and involves minimal disturbance to the patient.

Topics: Humans; Imino Acids; Intestinal Fistula; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Time Factors

Topics: Duodenum; Humans; Imino Acids; Methods; Postoperative Complications; Radionuclide Imaging; Stomach; Technetium; Technetium Tc 99m Lidofenin

Topics: Duodenum; Follow-Up Studies; Humans; Imino Acids; Postoperative Complications; Pylorus; Radionuclide Imaging; Stomach; Technetium; Technetium Tc 99m Lidofenin

Topics: Aged; Bile Ducts; Biliary Tract; Female; Humans; Imino Acids; Intestine, Small; Liver; Male; Middle Aged; Pancreas; Pancreatic Ducts; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

Topics: Bile Ducts; Cholecystectomy; Humans; Imino Acids; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Ultrasonography

The diagnostic possibility of hypertonic Oddi's sphincter dysfunction was evaluated in 100 cholecystectomized and 28 noncholecystectomized patients. An organic lesion interfering with free bile flow was ruled out in every case. The existence of the syndrome, i.e., the dysfunction of the Oddi's musculature, was verified using the morphine-choleretic test combined with either dynamic hepatobiliary scintigraphy or (in selected cases) percutaneous transhepatic cholangiography. Hypertonic Oddi's sphincter dyskinesia can be regarded as an independent clinical syndrome.

Topics: Ampulla of Vater; Amylases; Aspartate Aminotransferases; Cholecystectomy; Common Bile Duct Diseases; Dehydrocholic Acid; gamma-Glutamyltransferase; Humans; Imino Acids; Morphine; Movement Disorders; Muscle Hypertonia; Postoperative Complications; Radiography; Sphincter of Oddi; Syndrome; Technetium; Technetium Tc 99m Lidofenin

Tc-99m labeled HIDA imaging has been used to investigate suspected biliary leaks following orthotopic liver transplantation. In two patients the diagnosis of bile leakage was confirmed and appropriate surgical intervention undertaken. In a third patient, despite clinical suspicion, no leakage was apparent on HIDA imaging, and unnecessary surgery was avoided. HIDA imaging is a useful, noninvasive technique for confirming biliary leakage after liver transplantation.

Topics: Adult; Bile; Biliary Tract; Female; Humans; Imino Acids; Liver; Liver Transplantation; Male; Middle Aged; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

The diagnosis of papillary stenosis, occasionally seen after cholecystectomy, is confirmed by endoscopic retrograde cholangiopancreatography (ERCP), which demonstrates delayed emptying of contrast material into the duodenum for more than 45 minutes. The authors assessed 2,6-dimethyl phenyl carbamoyl methyl iminodiacetic acid labelled with technetium-99m (99mTc HIDA) as a less invasive procedure in these circumstances by comparing it with the findings from ERCP. Twenty-six patients who had pain after cholecystectomy were studied by continuous 1-hour scintigraphy after injection of 99mTc HIDA. Biliary flow was estimated by measuring uptake and clearance of the entire liver and common bile duct. Volunteers who had no pain after cholecystectomy served as controls. Of the 26 study patients, all 99mTc HIDA scan findings were within the control range in 11. Of these, 10 had normal biliary drainage confirmed by ERCP. The one patient with delayed drainage did not improve after endoscopic sphincterotomy. Two patients demonstrated pooling of 99mTc HIDA in cystic dilatations of the biliary tree, while the other 13 patients had obstruction of the distal common bile duct and impaired flow demonstrated on the 99mTc HIDA scan. All 13 of these patients had papillary stenosis proven by ERCP. The authors conclude that 99mTc HIDA scanning is a valuable, minimally invasive method of diagnosing papillary stenosis.

Topics: Ampulla of Vater; Cholangiopancreatography, Endoscopic Retrograde; Cholecystectomy; Common Bile Duct Diseases; Constriction, Pathologic; Humans; Imino Acids; Pain, Postoperative; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

A case of bronchobiliary fistula diagnosed by 99mTc-HIDA cholescintigraphy is presented. The fistula caused by a stenosing tumor of the left hepatic duct would probably have been missed without the use of delayed views and body fluids counting which increased the specificity of scintigraphic findings.

Topics: Bile Duct Neoplasms; Biliary Fistula; Bronchial Fistula; Cholecystectomy; Cholestasis, Extrahepatic; Diagnosis, Differential; Female; Hepatic Duct, Common; Humans; Imino Acids; Mastectomy; Middle Aged; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

The recent availability of iminodiacetic acid analogues labeled with technetium Tc 99m provides a safe and accurate noninvasive test of biliary function. Biliary scintigraphy is a simple and rapid method of detecting acute cholecystitis in particular but also of distinguishing acute biliary pancreatitis from nonbiliary pancreatitis, of evaluating the patency of the common duct in early obstruction, of assessing possible postcholecystectomy syndrome, of evaluating the patency of a biliary enteric bypass, and of detecting postoperative biliary leaks.

Topics: Acute Disease; Biliary Tract; Biliary Tract Diseases; Biliary Tract Surgical Procedures; Cholecystitis; Cholelithiasis; Cholestasis; Humans; Imino Acids; Methods; Postoperative Complications; Radiography; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Ultrasonography

Twenty-three patients with surgical diversion of the biliary tract were serially studied with ultrasonography and hepatobiliary scintigraphy using 99mTc-HIDA or 99mTc-disofenin. Refluxed biliary air resulted in nondiagnostic sonograms in 14% of cases. Persistent postoperative dilatation was present in five patients (22%). Scintigraphy allowed differentiation of biliary dilatation with obstruction from nonobstructed dilatation. By coordinating the noninvasive imaging results, those patients requiring study using direct injection of contrast material may be selected.

Topics: Adult; Aged; Bile Ducts, Intrahepatic; Biliary Tract; Biliary Tract Surgical Procedures; Cholestasis; Duodenum; Female; Humans; Imino Acids; Jejunum; Male; Middle Aged; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Technetium Tc 99m Lidofenin; Ultrasonography

Hepatobiliary scintigraphy was performed in 30 normals and 22 patients who had a bilio-intestinal anastomosis. The patient group included 12 without symptoms and 10 with upper abdominal symptoms. All the anastomoses studied were visualized and persisting dilatation of the bile ducts was recognized in 10/12 and 7/10, respectively. Mean time for bile duct and gut visualization was significantly lower in normals as compared with both patient groups. There were no differences of any statistical significance between the two patient groups. One patient with clinical suspicion of bile leakage from the anastomosis was confirmed. Patients with stricture of the anastomosis did not have characteristics which would distinguish them from patients in well-being. It is concluded that 99mTc-HIDA scintigraphy has a low sensitivity when used to disclose the causes of symptom giving malfunction of bilio-intestinal anastomoses. The exception to this is patients with bile leakage into the peritoneal cavity, in whom scintigraphy is the only non-invasive method which can reveal the condition.

Topics: Adult; Aged; Common Bile Duct; Female; Humans; Imino Acids; Intestine, Small; Liver; Male; Middle Aged; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin

In liver-transplant patients, it is always difficult to differentiate between rejection crises and extrahepatic biliary obstruction on the basis of standard biochemical tests alone. A case is reported of a patient who received a transplant following total hepatectomy performed because of a hepatoma. Scintigraphy with Tc-99m N-(dimethylphenylcarbamoylmethyl)iminodiacetic acid pointed conclusively to an obstructive process, which was confirmed at re-operation.

Topics: Cholestasis, Extrahepatic; Humans; Imino Acids; Liver Transplantation; Male; Middle Aged; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Transplantation, Homologous

Endoscopic retrograde cholangiography (ERCP), the most advanced of the gastrointestinal endoscopic procedures, provides both specific diagnostic information pertaining to diseases of the biliary tract and pancreas and definitive therapy available only with this modality. ERCP is safe and accurate, establishing a primary diagnosis in 80% of cases and, in experienced hands, cannulation is successful in 98%. In addition to cholangiography, pancreatography has been a significant achievement providing accurate diagnostic yield through direct cannulation and opacification of the pancreatic duct while permitting collection of secretions for cytological evaluation and chemical analyses. The therapeutic extension of ERCP, endoscopic papillotomy (EPT), is successful in 94% of cases in the treatment of common bile duct stones and papillary stenosis, providing comparable results to surgical procedures while reducing morbidity, mortality and convalescence. Because of the accuracy and safety of these procedures, they should be considered early in suspected diseases of the biliary tract and pancreas so that the clinician can establish a specific diagnosis and provide definitive therapy.

Topics: Biliary Tract Diseases; Cholangiopancreatography, Endoscopic Retrograde; Cholecystectomy; Cholestasis, Extrahepatic; Cholestasis, Intrahepatic; Gallbladder Diseases; Humans; Imino Acids; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis; Postoperative Complications; Technetium; Technetium Tc 99m Lidofenin

The authors exploited the elective biliary excretion of 99mTc-HIDA at adequate concentrations to afford visibility of intestinal segments more directly wetted by bile in a study of sequential hepatobiliary scintigraphy designed to explore the parts of the duodenum and jejunum that are excluded to the transit of gastrointestinal contents in many surgical procedures involving the proximal digestive tract. They illustrate their case material with several representative examples; these are described in detail to show the validity, usefulness and versatility of the scintigraphic technic under discussion.

Topics: Adult; Aged; Biliary Tract; Cholecystectomy; Female; Gastroenterostomy; Humans; Imino Acids; Intestines; Liver; Male; Middle Aged; Postgastrectomy Syndromes; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin