Normal Postcholecystectomy Appearance

The normal postcholecystectomy findings have been investigated using sonography and computed tomography (CT) [3-6]. Small amounts of fluid in the gallbladder fossa are commonly identified in the gallbladder bed on CT images and sonograms and may be seen up to at least 5 days after surgery (Fig. 4.2). The fluid should be only minimal in amount and poorly circumscribed, without distinct or bulging contours [7]. Fluid in the gallbladder fossa is generally considered to be due partly to small accumulations of bile that resolve spontaneously. Such fluid may result from interruption of accessory cystohepatic ducts, which are persistent embryological remnants between the liver and the biliary system, usually involving the gallbladder, found in approximately 30% of the population. One type of

Figure 4.2. Normal postcholecystectomy CT appearance. CT scan through the upper abdomen shows fluid in the gallbladder fossa after cholecystectomy. Fluid may be observed normally for up to at least 5 days after surgery.

cystohepatic duct; the duct of Luschka, is a persistent congenital connection between the biliary ducts in the right lobe of the liver and the gallbladder (Figs. 4.3 and 4.4) [8]. In one study, extrabiliary accumulation of radiotracer was identified in 44% of patients who had hepatobiliary scintigraphic (DISIDA) scanning 2 to 4 hours after open cholecystectomy, but only one patient developed a clinically significant bile leak [9]. This suggests, as other have speculated, that some cystic duct leaks heal spontaneously and some small leaks go undetected [7]. After cholecystectomy, no distinct or well-marginated fluid collections should be found in the gallbladder fossa, and the presence of such (the "pseudogallbladder sign"), or increasing fluid collections, should

Figure 4.3. Duct of Luschka. Cholecystostomy study demonstrates a short tubular structure extending from the superior aspect of the gallbladder extending toward the liver.

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