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E1109. Biliary Bungles: Imaging Review of Complications of Acute Cholecystitis and Cholecystectomy
Authors
  1. Krishna Kumar; Saint Luke's Hospital- Department of Radiology; University of Missouri- Kansas City
  2. Ranjit Chima; Stanford Medical Center- Department of Radiology
  3. Josh Floyd; Saint Luke's Hospital- Department of Radiology; University of Missouri- Kansas City
  4. Praveen Sankrithi ; Kansas City University of Medicine and Biosciences
  5. Madison Turner; Saint Luke's Hospital- Department of Radiology; University of Missouri- Kansas City
  6. Brian Do; Truman Medical Center- Department of Radiology; University of Missouri- Kansas City
  7. Daryl Pinedo; Saint Luke's Hospital- Department of Radiology
Background
Acute cholecystitis is a well-described entity. Although complications of acute cholecystitis are rarely encountered since the advent of laparoscopic cholecystectomy, acute cholecystitis left untreated can lead to a host of complications, including those of infectious, inflammatory or vascular etiologies. This educational poster will review the imaging of common and uncommon complications of acute cholecystitis- as well as select complications following cholecystectomy. The complications of acute cholecystitis and the dangers of cholecystectomy are not to be underestimated.

Educational Goals / Teaching Points
This exhibit will primarily review multimodality imaging findings, pathophysiology, relevant clinical data, and a timeline of common and uncommon complications of acute cholecystitis and cholecystectomy. The goal will be to rapidly review the common entities- and increase familiarity with the less common (for residents, fellows, and practicing radiologists with interest in abdominal imaging).

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Ultrasound is typically the preferred initial imaging modality in acute cholecystitis. Computed tomography (CT) is favored to diagnose complications of acute cholecystitis, such as gangrenous cholecystitis, hepatic abscess, emphysematous cholecystitis, fistulae (cholecystocutaneous, cholecystoduodenal, cholecystocolonic), and vascular complications (hemorrhagic cholecystitis and portal vein thrombosis). Magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) may be useful to evaluate entities such as Mirizzi Syndrome. Complications of cholecystectomy such as subcutaneous/intra-abdominal abscesses, bowel injury or rarely tumor seeding, can be diagnosed by CT. Biliary leaks can be diagnosed by nuclear medicine hepatobiliary scintagraphy (HIDA). MRI/MRCP is useful in the assessment of cholecystectomy complications including biliary injury, leak, or clip migration. Catheter-based angiography is used to diagnose and treat pseudoaneurysms caused by cholecystectomy or biliary procedures.

Conclusion
Acute cholecystitis has troubling sequelae, requiring both a high degree of suspicion to diagnose and a timely response to treat successfully. A delay in diagnosis could result in potentially fatal complications. Awareness of the spectrum of imaging manifestations of gallbladder disease from the acute presentation, untreated form, and postsurgical state can increase diagnostic accuracy and improve patient care.