Possible sites of a biliary leak
When a biliary leak occurs, where are the possible sites to observe the leak?
A biliary leak can occur anywhere along the biliary tree. However, such leaks usually occur in areas of prior surgical intervention or anastomoses. When performing a hepatobiliary scan to assess for a biliary leak, it is important to perform the test in the standard manner. Additional images of surgical drains and anterior projection images with the patient in lateral decubitus positions help to assess for subtle biliary leaks. Surgical drains should be evaluated for radiotracer activity, and it is important to know where these drains are actually located in the body. Drains in the surgical bed that have radiotracer activity suggest a leak in that area, whereas drains in the biliary tree should naturally have radiotracer activity. Images with lateral decubitus patient positioning can be obtained to assess for radiotracer activity in the peritoneal space, which would help to confirm a leak