Hepatobiliary Scintigraphy Monitoring Patency of Partial External Biliary Diversion in a Patient With Progressive Familial Intrahepatic Cholestasis

Ectopic Gallbladder in the Left Upper Abdomen Shown on Hepatobiliary Scintigraphy

ABSTRACT

The gallbladder is normally located in the right upper abdomen below the undersurface of the liver. We reported an ectopically located gallbladder, which was located in the left upper abdomen on hepatobiliary scintigraphy in an 18-year-old woman.

Ectopic Gallbladder Mimicking Choledochal Cyst on Hepatobiliary Scintigraphy

The gallbladder is generally located at the anterolaterally situated gallbladder fossa on the undersurface of the liver, whereas choledochal cyst, as a dilation of the common bile duct, is located more posteromedially. We reported an ectopically located gallbladder, which appeared to be a choledochal cyst on hepatobiliary scintigraphy in a 10-year-old girl.

Hepatobiliary scintigraphy during cholestatic and noncholestatic periods in patients with progressive familial intrahepatic cholestasis after partial external biliary diversion

BACKGROUND

The purpose of the study was to determine the distribution of excreted bile during cholestatic periods and in remission in patients with progressive familial intrahepatic cholestasis (PFIC) after surgery with partial external biliary diversion (PEBD), using hepatobiliary scintigraphy.

METHODS

Using intravenously administered technetium Tc 99m-labeled mebrofenin, the distribution of bile during periods of biochemical cholestasis and in remission was investigated in patients with PFIC operated with PEBD. Stomal bile, urine, and feces from the patients were collected during 24 hours after administration of technetium Tc 99m-labeled mebrofenin; and the fractions of remaining radioactivity in the 3 compartments and the remaining isotopic activity in the body were quantified using scintigraphy.

RESULTS

Nine patients (4 boys and 5 girls) were studied. The median age was 13 (range, 5-24) years, and they had been operated with PEBD at a median time of 10 (range, 4-14) years before entering the study. Thirteen scintigraphic examinations were analyzed: 8 during noncholestatic remission (n = 7 patients) and 5 during cholestasis (n = 3 patients). The patients studied during remission discharged a significantly larger fraction of isotopic activity through the stoma (median, 90% vs 22%; P < .05) and a significantly lower fraction through the urine (median, 2.5% vs 15%; P < .05) compared with the patients studied during cholestasis.

CONCLUSION

Hepatobiliary scintigraphy could detect substantial differences in the output of bile. Further studies are needed to determine whether these differences may explain the mechanism of the PEBD operation or merely are secondary to the degree of cholestasis.

Demonstration of a perihepatic abscess communicating with a fistula from the small bowel on hepatobiliary imaging

Abscess formation after abdominal surgery is not an uncommon complication. It is much less common for a collection to be the result of a fistulous tract from the bowel. We describe a patient who underwent a Tc-99m hepatobiliary (Choletec) scan for the workup of a perihepatic abscess, which confirmed the presence of a fistulous tract from the small bowel to a perihepatic collection.