• The Korean Journal of Nuclear Medicine Technology
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• v.12 no.3
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• pp.229-234
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• 2008

Hepatobiliary scintigraphy is very sensitivity of hepatic cell and gallbladder, biliary track atresia and biliary leakage. however, Hepatobiliary scan of biliary leakage diagnosis was separated determine biliary leakage and bowl drainage bile-juice. The object of this study will determine biliary leakage and bowl drainage bile-juice to hepatobiliary scintigraphy both decubitus position in bile leakage patients. Material & Methode: 31 patients (meal 14, Femeal 17), $51.1{\pm}14.4$ years. dynamic scan acquisition 60 farme for 60 minute on supine position. and delay scan was 2 hrs, 4 hrs, 24 hrs for 5 minute on supine, both decubitus position. Both decubitus position scan was kept for 5 minutes. Efficient of Hepatobiliary Scintigraphy both decubitus position in bile leakage patients was compared leakage size, density, image of supine position and both decubitus position. Results: 23 patients for 31 bile leakage patients was checked up function image or delay image, and 8 patients was checked up bile leakage on both decubitus. anatomical leakage location was supine position very well, but both decubitus position was separated bile leakage and moving bile-juice in bowl. also, uptake (counts/pixel) average of roi and bkg was supine 5.02, left decubitus 2.08, right decubitus 2.68. No. pixels of supine ROI counted 1.91 times than left decubitus, 1.05 times than right decubitus. Conclusion: 31 patient both decubitus position, but decubitus position was separated bile juice movement in bowl leakage location. also, It was compared ROI/BKG ratio and ROI No. pixels of supine, both decubitus in 38.5% patients. And No. pixels of supine position was large 19%, 5% than left decubitus, right decubitus, And density was in low 60%, 50% than left decubitus, right decubitus. It was mean bile leakage of ROI. so, If Hepatobiliary Scintigraphy was additional both decubitus position scan in bile leakage patients, this study will be more valuable in diagnosis of bile leakage.

• The Korean Journal of Nuclear Medicine Technology
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• v.22 no.1
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• pp.98-102
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• 2018

Purpose When examining patients with digestive system Leakage, it is not easy to distinguish between bile leakage and bleeding only with Planar images. I would like to evaluate the utility of leakage of bile, confirmation of gastrointestinal bleeding and location discrimination using SPECT-CT. Materials and Methods SPECT-CT was performed according to the request of the reading room after acquiring Planar image for a total of 13 patients, including 8 patients suspected of bile leakage and 5 patients suspected of gastrointestinal bleeding, among patients visiting this specification went. We used Symbia T16 from SIEMENS and Discovery 670 from GE. Planar and SPECT-CT images were evaluated with a score of 1 to 10 by 4 experienced nuclear medicine doctors. Using the sensitivity and the specificity, the evaluation of the inspection by the ROC curve was carried out. The final diagnosis was confirmed by follow-up observation as a result of reoperative surgery. Results The sensitivity, specificity and accuracy of SPECT-CT were 91.7%, 100% and 94.2%, respectively. Planar images were 83.3%, 68.8% and 78.8%, respectively. Planar images showed lower diagnostic accuracy compared to SPECT-CT (78.8%, 94.2%, p<0.05). Moreover, the reliability of the diagnosis of SPECT-CT by ROC curve analysis showed a more useful result than the Planar image (p<0.05). Conclusion SPECT-CT had high sensitivity and specificity for diagnosis of biliary leakage and gastrointestinal bleeding and location discrimination. When SPECT-CT is additionally performed together with Planar images, it may be considered to improve bile leakage and diagnosis of gastrointestinal bleeding patients and position discrimination evaluation. There is usefulness depending on the patient's age and position, but consideration of additional CT exposure may be done sufficiently.

• Tuberculosis and Respiratory Diseases
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• v.65 no.2
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• pp.131-136
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• 2008

Cholethorax (bilious pleural effusion) is an extravasation of bile into the thoracic cavity via a pleurobiliary fistula (and also a bronchobiliary fistula). It is an extremely rare complication of thoraco-abdominal injuries. It can be caused by congenital anomaly and also by hepatobiliary trauma, severe infection or iatrogenic procedures. The definitive diagnosis is made with aspiration of bilious fluid from the pleural space during thoracentesis, by finding a fistulous tract during endoscopic retrograde cholangiopancreatography (ERCP) or cholagioscopy, or with finding an abnormal pleural accumulation of radioisotope during hepatobiliary nuclear imaging. Its symptoms include coughing, fever, dyspnea and pleuritc chest pain. Herein we report on a case of cholethorax following performance of percutaneous transhepatic cholangioscopy (PTCS) to remove incidentally discovered common bile duct (CBD) stones.

• Journal of Trauma and Injury
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• v.27 no.3
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• pp.89-93
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• 2014

Bile leaks are complications that are much more frequent after a high-grade liver injury than after a low-grade liver injury. In this report, we describe the management of bile leaks that were encountered after angiographic embolization in a 27-year-old man with a high-grade blunt liver injury. He had undergone an abdominal irrigation and drainage with a laparotomy on post-injury day (PID) 16 due to bile peritonitis and continuous bile leaks from percutaneous abdominal drainage. He required three percutaneous drainage procedures for a biloma and liver abscesses in hepatic segments 4, 5 and 8, as well as endoscopic retrograde cholangiopancreatography with biliary stent placement into the intrahepatic biloma via the common bile duct. We detected communication between the biloma and the bilateral intrahepatic duct by using a tubogram. Follow-up abdominal computed tomography on PID 47 showed partial thrombosis of the inferior vena cava at the suprahepatic level, and the patient received anticoagulation therapy with low molecular weight heparin and rivaroxaban. As symptomatic improvement was achieved by using conservative management, the percutaneous drains were removed and the patient was discharged on PID 82.

• Journal of Veterinary Clinics
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• v.23 no.1
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• pp.72-76
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• 2006

A 1-year-old, female English cocker spaniel (ECS) dog was presented with 3-month history of vomiting and retaking of the vomitus, and chronic weight loss. The client had noticed mild abdominal distension 10 days before. The dog was diagnosed as chronic hepatitis with hepatic cirrhosis based on complete blood count (CBC), serum chemistry profiles, radiography, ascites assessment, bile acid evaluation, and liver biopsy through exploratory laparotomy and necropsy. CBC and serum chemistry profiles revealed mild anemia, slightly elevated hepatic enzymes (ALT and AST), increased creatinine kinase (CK), hyperammonemia, and hypoproteinemia with hypoalbuminemia. Ascites was transudate according to analysis of components. Bile acid assessment (fasting; $174.4{\mu}mol/L$ and postprandial; $198.4{\mu}mol/L$) showed strongly suspected hepatic insufficiency. On radiological findings, ascites was evident. Atrophied liver (especially left side lobes) and distended mesenteric vasculatures were observed by exploratory laparotomy. Histopathological examination of marginal lesion of left lateral lobe of liver by biopsy revealed the necrosis of hepatic cells, dilation of sinusoids, infiltration of neutrophils in sinusoids, and vacuolation of hepatic cytoplasm. The patient had been managed with careful low protein diet and specific supportive therapy (ursodeoxycholic acid, prednisolone, vitamine E, and interferon). Vomiting and ascites disappeared with medical management. The dog was monitored periodically by CBC, serum chemistry and radiographic examination. The dog survived more 18 months with medical therapy. After spontaneous death, necropsy and histopathologic examination were performed.

• Journal of Veterinary Clinics
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• v.24 no.3
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• pp.315-319
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• 2007

Transgastric endoscopic cholecystectomy was successfully accomplished in a 1-year-old, 15 kg, female, mongrel dog. Single-working channel flexible gastric endoscope was used with the aid of one abdominal laparoscopic port. Gastrotomy was performed using endoscopic needle knife at the ventral antral region. Through the gastric incision endoscope was advanced and retroflexed for the visualization of gallbladder. For the better exposure of surgical field, gentle traction was applied at the fundus of the gallbladder using laparoscopic grasping forceps. Cystic duct and artery was ligated using endoclips. After transecting the duct and artery, gallbladder was dissected using endoscopic coagulating grasping forceps and needle knife. Resected gallbladder was retrieved through the mouth and gastric incision site was sutured using endoclips. There was no evidence of bile leakage or stomach leakage on postoperative day (POD) 3. On POD 16, gastric endoscopy and laparoscopy was performed. Gastric endoscopy revealed complete adhesion of incision site. The content of the peritoneum appeared healthy, with no sign of infection, bile staining, or organ injury. The omentum was adhered over resected gallbladder fossa and the serosal surface of gastrotomy site. This is the first report of NOTES cholecystectomy in the dog and provides new concept of cholecystectomy of the dog.