Cholescintigraphy in biliary leak

How is cholescintigraphy used to diagnose and manage biliary leak? 

Cholescintigraphy is highly sensitive and specific for detecting biliary leak. Nonbile fluid collections are common after surgery and can significantly limit the specificity of anatomic studies. In cases of a postcholecystectomy bile leak, cholescintigraphy can demonstrate accumulation of activity in the gallbladder fossa with progressive activity in dependent regions, commonly the right paracolic gutter.

Additional delayed images up to 24 hours after injection can demonstrate small leaks. Because cholescintigraphy has poor spatial resolution, the exact origin of the leak may not be determined and endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography may be necessary for further anatomic assessment. Cholescintigraphy can also be used noninvasively to document resolution of a bile leak. Bilomas can also be detected if there is a focus of increased activity that correlates with a fluid collection noted on previous cross-sectional imaging.

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