Functional evaluation of cystic duct patency with Gd-EOB-DTPA MR imaging: an alternative to hepatobiliary scintigraphy for diagnosis of acute cholecystitis?

Endoscopic transpapillary gallbladder drainage (ETGBD) for acute cholecystitis is challenging. We evaluated the influence of pre-procedural imaging and cystic duct cholangiography on ETGBD. Patients who underwent ETGBD for acute cholecystitis were retrospectively examined. The rate of gallbladder contrast on cholangiography, the accuracy of cystic duct direction and location by computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP), and the relationship between pre-procedural imaging and the technical success of ETGBD were investigated. A total of 145 patients were enrolled in this study. Gallbladder contrast on cholangiography was observed in 29 patients. The accuracy of cystic duct direction and location (proximal or distal, right or left, and cranial or caudal) by CT were, respectively, 79%, 60%, and 58% by CT and 68%, 55%, and 58% by MRCP. Patients showing gallbladder contrast on cholangiography underwent ETGBD with a significantly shorter procedure time and a lower rate of cystic duct injury. No other factors affecting procedure time, technical success, and cystic duct injury were identified. Pre-procedural evaluation of cystic duct direction and location by CT or MRCP was difficult in patients with acute cholecystitis. Patients who showed gallbladder contrast on cholangiography showed a shorter procedure time and a lower rate of cystic duct injury.

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Utility of Intraductal Ultrasonography for the Assessment of Cystic Duct Patency to Evaluate the Risk of Acute Cholecystitis After Biliary Metallic Stent Placement

Gastrointestinal Endoscopy ◽

10.1016/s0016-5107(04)00890-9 ◽

2004 ◽

Vol 59 (5) ◽

pp. P191

Author(s):

Yousuke Nakai ◽

Hiroyuki Isayama ◽

Yutaka Komatsu ◽

Takeshi Tsujino ◽

Nobuo Toda ◽

...

Keyword(s):

Acute Cholecystitis ◽

Cystic Duct ◽

Stent Placement ◽

Metallic Stent ◽

Intraductal Ultrasonography ◽

Metallic Stent Placement

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Abnormally increased iron concentration in basal ganglia in Shy-Drager syndrome MR imaging and autonomic study: RM imagem e estudo autonômico

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x1991000300020 ◽

1991 ◽

Vol 49 (3) ◽

pp. 342-347 ◽

Cited By ~ 2

Author(s):

Jayme A. Maciel Jr. ◽

Cristiane M. da Rocha ◽

Sandra Cabelho ◽

Mario G. Pradal

Keyword(s):

Basal Ganglia ◽

Mr Imaging ◽

Laboratory Tests ◽

Autonomic Failure ◽

Iron Concentration ◽

Pure Autonomic Failure ◽

Functional Evaluation ◽

High Field Strength ◽

Syndrome Diagnosis ◽

Early Case

Report of an early case of Shy-Drager syndrome in a 67 year-old woman patient. Autonomic failure was diagnosed by functional evaluation as well as laboratory tests. MR imaging disclosed a prominent putamina hypodensity in T2-weighted images at high field strength due to iron increased depositing in this basal ganglia. MR imaging evidences confirm Shy-Drager syndrome diagnosis, and contributes for differential diagnosis of idiopathic hypotension (pure autonomic failure) in special in SDS early cases.

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Diagnostic evaluation of hepatobiliary scintigraphy using99mTc-N-pyridoxyl-5-methyltryptophan in acute cholecystitis

Gastroenterologia Japonica ◽

10.1007/bf02779488 ◽

1988 ◽

Vol 23 (5) ◽

pp. 553-558

Author(s):

Tadahiro Takada ◽

Hideki Yasuda ◽

Katsuhiro Uchiyama ◽

Hiroshi Hasegawa ◽

Junichi Shikata ◽

...

Keyword(s):

Acute Cholecystitis ◽

Diagnostic Evaluation ◽

Hepatobiliary Scintigraphy

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Hepatobiliary Scintigraphy in an Immunosuppressed Patient with Hepatocellular Dysfunction and Acute Cholecystitis: Diagnostic Dilemmas Posed by Delayed Gallbladder Visualization

Clinical Nuclear Medicine ◽

10.1097/00003072-199809000-00006 ◽

1998 ◽

Vol 23 (9) ◽

pp. 591-593

Author(s):

ZAKARIA ASSI ◽

NICOLAAS I. BOHNEN ◽

BRAHM SHAPIRO

Keyword(s):

Acute Cholecystitis ◽

Immunosuppressed Patient ◽

Hepatobiliary Scintigraphy

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Functional evaluation of transplanted kidneys in normal function and acute rejection using BOLD MR imaging

European Journal of Radiology ◽

10.1016/j.ejrad.2011.02.041 ◽

2012 ◽

Vol 81 (5) ◽

pp. 838-845 ◽

Cited By ~ 16

Author(s):

Wenbo Xiao ◽

Jingjing Xu ◽

Qindong Wang ◽

Ying Xu ◽

Minming Zhang

Keyword(s):

Mr Imaging ◽

Acute Rejection ◽

Normal Function ◽

Functional Evaluation ◽

Transplanted Kidneys

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OMENTUM PIECE FOR PREVENTION OF BILE LEAKAGE AFTER SUBTOTAL CHOLECYSTECTOMY

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i1.872 ◽

2020 ◽

Vol 4 (1) ◽

Author(s):

Kaustubh Vasant Waikar

Keyword(s):

Gall Bladder ◽

Acute Cholecystitis ◽

Cystic Duct ◽

Primary Closure ◽

Bile Leak ◽

Bile Leakage ◽

Greater Omentum ◽

Closure Technique ◽

Subtotal Cholecystectomy ◽

History Of

Introduction: Acute cholecystitis is an acute inflammatory condition of the gallbladder of which 95% of cases of acute cholecystitis are due to an obstructing calculus in the gallbladder neck or cystic duct. Acute cholecystitis and difficult gall bladder have severe inflammation and anatomical deformities i.e. empyema, Mirizzi syndrome and sometimes gangrene. In recent years, there is an increasing trend towards subtotal cholecystectomy and general acceptance is higher due to higher incidence of complications in difficult gall bladder. Although, the results of subtotal cholecystectomy are satisfactory but the post-operative bile leak is a problem of great concern. There are many techniques that have been adopted, but bile leakage compared to closing of cystic duct directly is very high in subtotal cholecystectomy. Material and Methods: The Omentum Plugging Technique (OPT) and Primary Closure Technique (PCT) was done to prevent bile leak in cases were total cholecystectomy could not be performed. Patients were included in the study with the diagnosis of cholelithiasis and patients who had undergone subtotal cholecystectomy for gallstone diseases with both OPT and PCT Technique. Under general anaesthesia patients were operated. Patients were first decompressed at the fundus with the suction and harmonic scalpel or l-hook was used for transection of gall bladder and wash was given and both the anterior and posterior walls were excised leaving an anterior and posterior wall intact and OPT, a piece of omentum that matches the size of the opening of the gallbladder stump is resected from the greater omentum and plugged into the gallbladder stump. Results: A total of 486 patients were operated, of which 36 patients (7.4%) underwent subtotal cholecystectomy because it was not possible to close their cystic ducts because they had difficult gallbladders, of which 18 patients in taken in OPT and 18 patients taken in PCT group. Average age in OPT group was 49.48 ± 9.59 years while in PCT group was 54.47 ± 16.21. In OPT group there were 10 (62.5%) male and 6 (37.5%) female, in PCT group 11 (68.75%) male and 5 (31.25%) female were observed. History of CBD Stone was recorded in 3 (18.75%) and 2 (12.50%) patients in OPT and PCT group respectively. No History of Abdominal Surgery was noted in both the group. Intra-operative Haemorrhage in OPT Group was 118 (16-359) ml while in PCT group was 164 (10-578) ml. Duration of Operation Time OPT Group was 156 ± 15.77 ml while in PCT group it was 105 ± 17.35 minutes. Total post-operative complications and post-operative bile leakage were seen in 2 patients in OPT group while in PCT group it was seen in 10 patients. (P= 0.0040). Post-operative intervention was done on one patient in OPT group and on 9 patients in PCT group. Mean Duration of drain was 3.5 ± 1.24 days in OPT group and 8.59 ± 2.46 days in PCT group (P< 0.0001). Post-operative hospital stay was 8.84 ± 2.14days in OPT group and 13.45 ± 2.11days (P< 0.0001). Conclusion: In a difficult gall bladder SC is required during cholecystectomy and for prevention of postoperative bile leakage OPT technique can be safe and more feasible alternative than conventional procedures. Keywords: Subtotal cholecystectomy (SC), Omentum Plugging Technique (OPT), Primary Closure Technique (PCT), gall bladder.

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