Ultrasound and HIDA: scanning in evaluating bile leaks after cholecystectomy

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.