Sonography accurately detects biliary obstruction in patients with surgically created biliary-enteric anastomosis

Resolution of pneumobilia as a predictor of biliary stent occlusion

OBJECTIVE

To predict biliary stent occlusion on computed tomography (CT) from the loss of pneumobilia.

METHODS

A total of 66 patients with common bile duct stents with pneumobilia after initial stent placement had a follow-up CT and diagnostic endoscopic retrograde cholangiopancreatography (ERCP). Two readers evaluated all CT exams for pneumobilia. Resolution or decrease of pneumobilia on CT was compared with ERCP findings.

RESULTS

Sensitivity and specificity was 60-64% and 95% with a positive predictive value of 97% and a negative predictive value of 49-51%.

CONCLUSION

Resolution or reduction of pneumobilia after stent placement is specific (95%) and is moderately accurate (70-73%) for predicting biliary stent occlusion.

Pancreaticobiliary ductal system: value of half-Fourier rapid acquisition with relaxation enhancement MR cholangiopancreatography for postoperative evaluation

PURPOSE

To assess the usefulness of half-Fourier rapid acquisition with relaxation enhancement (RARE) magnetic resonance cholangiopancreatography (MRCP) for evaluation of postoperative changes in the pancreaticobiliary ductal system.

MATERIALS AND METHODS

The study included 34 patients (20 men, 14 women; mean age, 65.5 years) who underwent surgery of the pancreaticobiliary ductal system. Half-Fourier RARE MRCP images were obtained after surgery. Qualitative evaluation included ratings by two observers for depiction of postoperative anatomy and for artifacts, as well as analysis of postoperative complications. Direct cholangiographic, computed tomographic, and ultrasonographic findings and 6-month follow-up results were the reference standard. Sensitivity, specificity, and accuracy were calculated for the evaluation of postsurgical complications seen at half-Fourier RARE MRCP.

RESULTS

The sensitivity, specificity, and accuracy of MRCP for the evaluation of postsurgical complications were each 100% for ductal dilatation; 100%, 87%, and 89%, respectively, for choledochoenteric anastomotic stricture; 100%, 86%, and 87%, respectively, for pancreaticoenteric anastomotic stricture; 100% each for intraductal stones and anastomotic leakage; and 80%, 100%, and 94%, respectively, for cholangitis.

CONCLUSION

Half-Fourier RARE MRCP is a reliable imaging technique for the evaluation of anatomy and of complications associated with a surgically altered pancreaticobiliary ductal system.

Case report: ultrasound diagnosis of obstructed Roux loop after cancer of the pancreas or bile duct

We describe three cases with known pancreatic or bile duct neoplasia treated by surgery who subsequently presented with obstructive jaundice. In all cases ultrasound demonstrated a fluid-filled obstructed Roux loop and a patent biliary-enteric anastomosis. The cause of the obstruction was seen in two cases. Ultrasound is a safe, fast, reliable and non-invasive method in the assessment of these patients.