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Title: Role of HIDA scanning in the assessment of external biliary fistulae

Abstract

Three patients with postoperative external biliary fistula are described. In each, radionuclide /sup 99m/Tc HIDA was used to define the anatomy of the fistula. The extent of the fistula and the presence of distal obstruction to bile flow could also be determined. This information was used to predict the likelihood of spontaneous fistula closure. HIDA scanning is a useful noninvasive alternative to other investigations, such as fistulography and cholangiography, which do not always provide useful information. The results of HIDA scanning can aid the clinical decision on the need for surgical intervention to correct an external biliary fistula.

Authors:
; ; ;
Publication Date:
Research Org.:
Royal Postgraduate Medical School, London, England
OSTI Identifier:
5519767
Resource Type:
Journal Article
Resource Relation:
Journal Name: Surg. Gastroentarol.; (United States); Journal Volume: 3:1
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BILIARY TRACT; FISTULAE; RADIOISOTOPE SCANNING; DIGESTIVE SYSTEM DISEASES; DIAGNOSIS; LABELLED COMPOUNDS; PATIENTS; TECHNETIUM 99; TRACER TECHNIQUES; BETA DECAY RADIOISOTOPES; BETA-MINUS DECAY RADIOISOTOPES; COUNTING TECHNIQUES; DIGESTIVE SYSTEM; DISEASES; HOURS LIVING RADIOISOTOPES; INTERMEDIATE MASS NUCLEI; ISOMERIC TRANSITION ISOTOPES; ISOTOPE APPLICATIONS; ISOTOPES; NUCLEI; ODD-EVEN NUCLEI; PATHOLOGICAL CHANGES; RADIOISOTOPES; TECHNETIUM ISOTOPES; YEARS LIVING RADIOISOTOPES 550601* -- Medicine-- Unsealed Radionuclides in Diagnostics

Citation Formats

McPherson, G.A., Collier, N.A., Lavender, J.P., and Blumgart, L.H. Role of HIDA scanning in the assessment of external biliary fistulae. United States: N. p., 1984. Web.
McPherson, G.A., Collier, N.A., Lavender, J.P., & Blumgart, L.H. Role of HIDA scanning in the assessment of external biliary fistulae. United States.
McPherson, G.A., Collier, N.A., Lavender, J.P., and Blumgart, L.H. 1984. "Role of HIDA scanning in the assessment of external biliary fistulae". United States. doi:.
@article{osti_5519767,
title = {Role of HIDA scanning in the assessment of external biliary fistulae},
author = {McPherson, G.A. and Collier, N.A. and Lavender, J.P. and Blumgart, L.H.},
abstractNote = {Three patients with postoperative external biliary fistula are described. In each, radionuclide /sup 99m/Tc HIDA was used to define the anatomy of the fistula. The extent of the fistula and the presence of distal obstruction to bile flow could also be determined. This information was used to predict the likelihood of spontaneous fistula closure. HIDA scanning is a useful noninvasive alternative to other investigations, such as fistulography and cholangiography, which do not always provide useful information. The results of HIDA scanning can aid the clinical decision on the need for surgical intervention to correct an external biliary fistula.},
doi = {},
journal = {Surg. Gastroentarol.; (United States)},
number = ,
volume = 3:1,
place = {United States},
year = 1984,
month = 1
}
  • Purpose: To evaluate the efficacy of covered stents for the treatment of transjugular intrahepatic portosystemic shunt (TIPS) obstruction in human subjects with identified or suspected biliary fistulae. Methods: Five patients were treated for early failure of TIPS revisions. All had mid-shunt thrombus, and four of these had demonstrable biliary fistulae. Three patients also propagated thrombus into the native portal venous system and required thrombolysis. TIPS were revised in four patients using a custom-made polytetrafluoroethylene (PTFE)-covered Wallstent, and in one patient using a custom-made PTFE-covered Gianturco Z-stent. Results: All identified biliary fistulae were successfully sealed. All five patients maintained patency andmore » function of the TIPS during follow-up ranging from 2 days to 21 months (mean 8.4 months). No patient has required additional revision. Thrombosis of the native portal venous system was treated with partial success by mechanical thrombolysis. Conclusion: Early and recurrent failure of TIPS with mid-shunt thrombosis, which may be associated with biliary fistulae, can be successfully treated using covered stents. Stent-graft revision appears to be safe, effective, and potentially durable.« less
  • Discordant hepatic uptake between Tc-99m HIDA and Tc-99m colloid occurred in a 63-year-old female with segmental biliary obstruction due to cholangioma. Radiographic CT and a percutaneous transhepatic cholangiogram revealed the obstructed right hepatic duct as well as the dilated intrahepatic duct in the right lobe. At surgery this was confirmed, and a 2 cm mass encasing the right hepatic duct was identified. It should be included in the gamut of discordant hepatic uptake of Tc-99m IDA and Tc-99m colloid.
  • Segmental biliary obstruction as a result of primary or secondary hepatic malignancy has been reported with increasing frequency. For two representative patients, the clinical and Tc-99m HIDA scintigraphic findings in segmental biliary obstruction are described. The presence of photon-deficient dilated bile ducts in one segment of the biliary tree is highly suggestive of localized biliary obstruction and should be considered in the patient with suspected or proven hepatic malignancy despite the absence of jaundice.
  • Segmental biliary obstruction as a result of primary or secondary hepatic malignancy has been reported with increasing frequency. For two representative patients, the clinical and Tc-99m HIDA scintigraphic findings in segmetal biliary obstruction are described. The presence of photon-deficient dilated bile ducts in one segment of the biliary tree is highly suggestive of localized biliary obstruction and should be considered in the patient with suspected or proven hepatic malignancy despite the absence of jaundice.
  • The diagnostic accuracy of biliary scanning using /sup 99m/Tc-pyridoxylideneglutamate has been determined in a series of 51 surgically jaundiced patients. This noninvasive technique was found to be safe, reliable and universally applicable in all instances of jaundice, regardless of the serum bilirubin value or prothrombin time. The results were found to compare favorably with those of other investigative procedures. It is suggested that the /sup 99m/Tc-pyridoxylideneglutamate biliary scan is most advantageously carried out after clinical assessment and full biochemical evaluation of the patient. The scan result will indicate the next logical step in the management of the patient whether itmore » be endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, biopsy of the liver or laparotomy.« less