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E1778. Review of Post-Cholecystectomy Syndrome: Imaging Biliary Complications and Emergencies
Authors
  1. Charlie Park; Emory University School of Medicine
  2. Derek Hsu; Emory University School of Medicine
  3. Carrie Hoff; Emory University School of Medicine
  4. Kiran Maddu; Emory University School of Medicine
Background
Cholecystectomy is the most commonly performed intra-abdominal surgical procedure in the United States with 1.5 million performed annually and is predominantly performed laparoscopically. Although largely safe, laparoscopic cholecystectomy results in higher rates of abdominal symptoms consisting of abdominal pain and dyspepsia, which may persist or recur, collectively known as post-cholecystectomy syndrome. Cholecystectomy complications can be broadly divided in to biliary, vascular and infectious causes.

Educational Goals / Teaching Points
This educational exhibit aims to 1) Provide an overview of post-cholecystectomy syndrome with an emphasis on biliary complications and emergent imaging findings, 2) Illustrate the spectrum of imaging findings of early and late post-cholecystectomy complications 3) Enumerate the role of various imaging modalities in the evaluation of post cholecystectomy complications and address the role of selective trans-catheter coil embolization in the management of bile-leak. 4) Discuss pearls and pitfalls in imaging following cholecystectomy.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
While common first-line imaging modalities for post-cholecystectomy complications include CT and sonography, ERCP and MRCP can delineate the biliary tree with greater detail. Scintigraphy has a higher sensitivity and specificity than CT or sonography for diagnosing bile leak and may preclude the need for ERCP. Post-operative complications include biliary duct injury or leak, biliary obstruction, remnant gallbladder/cystic duct stones and inflammation, biliary dyskinesia, papillary stenosis, and vascular injury. Subtle cases resulting in lethal outcomes such as hemorrhage from the gallbladder bed without major vessel injury, have also been described. Cases presented will include biliary complications such as post-cholecystectomy stump cholecystitis, nonbiliary complications such as subcapsular hematoma, and normal post-surgical findings such as oxidized regenerated cellulose. The exhibit includes a brief literature review on the role of radiologist in the management of biliary complications.

Conclusion
Post-operative biliary complications of laparoscopic cholecystectomy can cause significant morbidity and mortality, therefore, understanding the spectrum of complications and associated imaging findings are crucial in directing appropriate patient management.