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Figure 4.4. Leak from duct of Luschka. (A) Film from an ERCP demonstrates extraluminal contrast medium extending from peripheral ducts at the edge of the liver. (B) DISIDA scan in the same patient showing radioactive tracer in the same location.
Figure 4.5. Biliary intravenous leak with "pseudogallbladder sign." CT scan of the upper abdomen without contrast medium, shows a large fluid collection with bulging contours in the gallbladder fossa. Fluid is also present in the right subhepatic space.

suggest a biliary leak or biloma (Fig. 4.5). Subhepatic fluid collections have been identified by sonography in 20% of asymptomatic patients after open cholecystectomy [10]. The fluid may consist of bile, blood, serous fluid, or lymph, owing to oozing from surgical trauma from patients with gallbladders partially or completely intrahepatic or adherent to the liver due to chronic cholecystitis. The persistence of this material depends on the efficiency of peritoneal absorption and the external drainage provided.

The use of Penrose drains is controversial, but subhepatic fluid collections have been demonstrated in only 5% of patients after open cholecystectomy with drains as opposed to 20% without them [11]. Small amounts of pelvic or intra-abdominal fluid may also be observed normally following LC. Small amounts of free intraperitoneal air are commonly identified after LC, since carbon dioxide is introduced into the peritoneal cavity during surgery. The gas is usually rapidly absorbed. Subcutaneous emphysema, due to dissection of carbon dioxide around the trocar sites, is also commonly identified (Fig. 4.6).

Figure 4.6. Subcutaneous emphysema after laparoscopic cholecystectomy.

Supine view of the abdomen after laparoscopic cholecystectomy shows subcutaneous emphysema in the lateral abdominal wall.

Figure 4.6. Subcutaneous emphysema after laparoscopic cholecystectomy.

Supine view of the abdomen after laparoscopic cholecystectomy shows subcutaneous emphysema in the lateral abdominal wall.

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