Hepatobiliary scintigraphy and scintiangiography in abdominal trauma

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.