Postoperative Tc-99m DISIDA hepatic extravascular diffusion mimicking biliary leakage

Postcholecystectomy hepatic extravascular leakage in the operative bed can mimic biliary leakage if a Tc-99m DISIDA study is performed in the first few days after surgery. In the case being reported here, the gallbladder was located partially intrahepatic and was not inflamed at the time of surgery. A Tc-99m DISIDA study was requested 5 days after surgery to evaluate biliary patency and to exclude biliary leakage. Increased uptake in the gallbladder fossa inside the liver at the operative site was detected in the early period of the study. It could be differentiated from biliary leakage by three important features: the early appearance of radioactivity in the first 30 minutes, the intensity of the abnormal focal increased activity decreased with time during the 60 minutes of the dynamic acquisition, and this activity did not increase or move with time. In true leakage, the abnormal activity should become more intense, should increase in size, and should progressively spread from its original site.