Thursday, June 4, 2015

Comes in Yellow and Black

A few days post-op from a laparoscopic cholecystectomy, a patient continues to have pain, fever, abdominal distension, ileus, and jaundice. Unfortunately, the drain placed after the lap chole was pulled out when the patient was agitated. The patient gets further imaging and a procedure shown below.

Challenge: What's shown in the images above?

Images shown under Fair Use.


RaH said...

My guess would be that they did en ERCP (Endoscopic retrograde cholangiopancreatography)
there is a possibility of leakage after a lap. chol. and risk of damage of the d. choledochus.
or it is just the PCS.. which i do not totally understand.
and the last thing that comes to mind is a subhepatic abcess.
a bile leak and an abcess could match the kind of images.
but the accumulation of contrast material indicates more a leak, an abcess wouldnt take contrast.
these two seem the most plausible to me.

Craig Chen said...

yes - it's a bile leak and images from an ERCP. great thought process. scary how lap choles are so common but serious complications can happen
Comes in Yellow and Black

The title refers to medieval humors; there was yellow bile and black bile. The CT (first image panel A) shows a large biloma in the gallbladder fossa; image B shows a plastic stent in the bile duct (arrowhead) and percutaneous pigtail in the biloma (arrow); image C is the biloma after contrast injection. The second image shows an ERCP with bile leak (double arrow) and pigtail catheter (arrowhead); panel B shows a plastic stent in the bile duct; panel C shows a complex biloma with air bubbles; panel D shows the percutaneous catheter in the biloma.

Source: UpToDate.