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Positional biliary stasis: scintigraphic findings following biliary-enteric bypass surgery
M H Lucas1, A H Elgazzar, D D Cummings
1Eugene L. Saenger Radioisotope Laboratory, Department of Radiology, University of Cincinnati Hospital, OH 45267-0577.
Summary
Hepatobiliary scintigraphy can reveal positional biliary stasis after surgery. Imaging patients in an upright position can help differentiate true obstruction from positional effects, improving diagnostic accuracy.
Area of Science:
- Nuclear Medicine
- Gastroenterology
- Surgical Imaging
Background:
- Postoperative biliary obstruction is a common complication after biliary enteric bypass surgery.
- Hepatobiliary scintigraphy is a key noninvasive tool for evaluating biliary complications.
Observation:
- A patient exhibited a scintigraphic pattern suggesting partial biliary obstruction during a supine 99mTc hepatobiliary study.
- This apparent stasis resolved when imaging was repeated in an upright position.
Findings:
- Positional changes significantly altered the hepatobiliary scintigraphy results, indicating the stasis was not due to a fixed obstruction.
- Repeat imaging in the upright position confirmed the absence of progressive activity accumulation at the anastomosis.
Implications:
- Biliary stasis can be a positional phenomenon, particularly in postoperative patients.
- Consider upright imaging to accurately diagnose biliary complications and avoid misinterpreting positional stasis as obstruction.