Pthc Collection 2013

Pthc Collection 2013

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The CT-scan is more specific in determining the presence of stones and is best utilized as an adjunct to US, because of the risk of free peritoneal fluid and presence of gas causing artifacts. It is often performed if the initial US is inconclusive or if more than one collection is present. It is often carried out prior to attempted treatment of a suspected biliary fistula (Fig. 2, 4).

Ultrasound and CT-scan are sensitive in detecting fluid collections, but not specific for the diagnosis of biliary leaks. The highest yield for a successful diagnosis of a bile leak comes from a combination of repeated ultrasounds and CT-scans. When a bile leak is suspected, other diagnostic modalities should be employed in order to confirm the diagnosis. If the diagnosis is uncertain, percutaneous radiological or surgical drainage is indicated. Percutaneous drainage is associated with higher complication rate and should be used with caution. It should be performed under ultrasound guidance or a CT-scan, unless there are no facilities in the area. The decision of which drainage modality to use should be made based on the clinical presentation and accuracy of CT-scan and US in the diagnosis of bile leak.

The percutaneous drainage is usually the treatment of choice. Percutaneous drainage can be performed under US, CT or fluoroscopic guidance. CT-guidance allows precise placement of the catheter tip in the collection and is more accurate in diagnosing free fluid, while US and fluoroscopic guidance allows dilatation of the bile ducts and insertion of stent. However in some patients, a catheter may be placed transhepatically in the percutaneous drainage of a biloma.9

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