Multimodality Imaging of Cholecystectomy Complications

Area of Science:

• Radiology
• Gastroenterology
• Surgical Oncology

Background:

• Cholecystectomy is a highly prevalent surgical procedure in the United States.
• Postoperative complications, though uncommon, are frequently encountered by radiologists due to the surgery's high incidence.
• Clinical diagnosis of complications can be challenging due to vague and nonspecific symptoms.

Purpose of the Study:

• To provide a comprehensive overview of cholecystectomy complications.
• To categorize complications into four main groups: biliary, stone-related, iatrogenic, and gallbladder-related.
• To emphasize the importance of multimodality imaging in the postoperative evaluation.

Main Methods:

• Discussion of surgical techniques and expected postoperative findings.
• Systematic description of complications categorized into four groups.
• Review of imaging modalities including ultrasound, CT, hepatobiliary scintigraphy, SPECT/CT, and MRI.

Main Results:

• Complications are classified into biliary (bile leaks, bilomas, obstruction, stricture), stone-related (retained/recurrent stones, spillage), iatrogenic (hemorrhage, vascular injury, pseudoaneurysms, duodenal injury, clip migration), and gallbladder-related (recurrent cholecystitis, unexpected cancer).
• Immediate and delayed complications can occur, presenting diagnostic challenges.
• Multimodality imaging is essential for accurate diagnosis.

Conclusions:

• A structured approach to imaging is vital for diagnosing a wide spectrum of cholecystectomy complications.
• Understanding surgical techniques and potential complications aids in accurate interpretation.
• Advanced imaging techniques play a complementary role in the comprehensive workup of postoperative patients.