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E1664. Gone but Not Forgotten: Common and Peculiar Complications of Cholecystectomy and Cholecystostomy
Authors
  1. Emily Brady; NY-Presbyterian Hospital - Weill Cornell Medical Center
  2. Fernanda Mazzariol; NY-Presbyterian Hospital - Weill Cornell Medical Center
Background
Over 600,000 cholecystectomies are performed yearly in the United States, mostly for the treatment of cholecystitis and symptomatic cholelithiasis. Percutaneous or endoscopic cholecystostomy are the treatment when the surgical risk is excessive. This exhibit will discuss the imaging of complications from cholecystectomy, percutaneous cholecystostomy and endoscopic cholecystogastrostomy and their management.

Educational Goals / Teaching Points
1. To be aware of the spectrum of complications that can occur after cholecystectomy or cholecystostomy. 2. Discuss the imaging appearance and clinical implications and management for a variety of postoperative biliary complications. 3. Review the merits of various imaging modalities in the detection of post-procedural complications. 4. Discuss normal postoperative appearances that can mimic pathology and features that assist in identifying the normal postoperative state.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Multimodality illustrated examples of the following pathology but not restricted to: Imaging findings which may simulate disease: Surgicel in the surgical bed, prominent cystic duct remnant with stone formation, dropped gallstones without abscess, common bile duct dilatation, notch versus kink of an endoscopic stent. Complications common to surgery and biliary interventions: Abscess, biloma and hematoma. Laparoscopic Cholecystectomy: biliary leak, common bile duct ligation (early) or stricture (late), dropped gallstones with abscess, retained gallstones (choledocholithiasis), vascular injury and adjacent organ injury (bowel), trochar site hernia. Percutaneous Cholecystostomy: Stent migration or obstruction, inadequate drainage, bilothorax. Endoscopic cholecystogastrostomy: Stent migration, gastric outlet obstruction, inadequate drainage, bleeding with pseudoaneurysm.

Conclusion
Familiarity with the imaging of complications from cholecystectomy and other gallbladder interventions will help the radiologist advise the clinician for prompt management of these complications.