The role of nuclear scintigraphy of suspected bile duct injury following laparoscopic cholecystectomy

Nuclear scintigraphy is a rapid and non-invasive tool for the diagnosis of suspected bile duct injury following laparoscopic cholecystectomy. We describe our experience with this technique in 19 out of more than 1,000 cases of laparoscopic cholecystectomy in our department. Of the five patients in whom nuclear scintigraphy revealed abnormalities, three showed bile leak to the peritoneum and underwent immediate laparotomy. Only one of these required choledochojejunostomy; in the others the leak would have closed spontaneously without surgery. In the remaining two patients there was apparently no passage to the duodenum on nuclear scintigraphy. Endoscopic retrograde cholangiopancreatography (ERCP) performed in one showed a normal bile duct. In the other patient, repeated scintigraphy done 12 h later, prior to ERCP, showed normal passage to the duodenum. Our experience indicates that laparotomy could have been avoided had ERCP been performed first. Therefore, we suggest that if nuclear scintigraphy fails to demonstrate passage to the bowel or shows a bile leak, ERCP is indicated.