Technetium-99m-HIDA scintigraphy versus endoscopic retrograde cholangiopancreatography in demonstrating bile leaks after laparoscopic cholecystectomy.

In two patients who had laparoscopic cholecystectomy, the postoperative course was complicated by continuous bilious drainage from the surgical drain in one and by jaundice in the other. In both patients, the findings of 99mTc-N-substituted-2,6-dimethylphenyl carbamoylethyl iminodiacetic acid (HIDA) scanning were interpreted as clearly demonstrating a significant bile leak in one and the complete absence of bile passage from the liver to the intestines in the other. These findings could result from either spontaneous closure of the bile leak or false-positive HIDA scans. Subsequent endoscopic retrograde cholangiopancreatography (ERCP) showed the common bile duct and the cystic duct to be normal, without any evidence of bile leakage or any problem with drainage to the intestines. In all patients who have a positive 99mTc-HIDA scan, ERCP should be performed before deciding on further surgical intervention.