Hepatobiliary scintigraphy for the diagnosis of bile leaks produced after Ttube removal in orthotopic liver transplantation

Choledochocholedochostomy (CC) over a T-tube is a well-recognized technique for biliary reconstruction in orthotopic liver transplantation (OLT). Bile leaks after T-tube removal are common, having a significant morbidity. The aim of this study was to evaluate the utility of hepatobiliary scintigraphy (HSB) for diagnosing bile leaks in liver transplant patients who develop abdominal pain after T-tube removal. Twenty consecutive patients (14 males, 6 females; mean age 44 years) were studied. The interval between T-tube removal and HBS ranged from 8 to 120 h. Hepatobiliary scintigraphy was carried out after the intravenous injection of 185 MBq 99Tcm-mebrofenin. A final diagnosis of bile leak was based on surgical, endoscopic retrograde cholangiopancreatography (ERCP) and ultrasound data, and clinical outcome. There were 13 patients with and 7 without bile leaks. On the scintigraphic images, bile leaks were defined as activity outside the biliary tract which moved along the right paracolic gutter, or the progressive accumulation of activity related to fluid collections as seen on ultrasound. Nine of 12 patients needed surgical repair; the other 3 were treated with endoscopic sphincterotomy. One patient with a negative HBS developed an abdominal abscess after aspirative puncture of a biloma. In the seven patients without bile leaks, all scintigrams showed normal biliary transit of activity. A diagnosis of no bile leaks was based on clinical follow-up in five patients and by ERCP in two patients. Based on these results, we conclude that HBS is an effective method for the diagnosis of bile leaks after T-tube removal in liver transplant patients.