Diagnosis of postoperative bile leak and accurate localization of the site of leak by gadobenate dimeglumine-enhanced MR cholangiography in a child

Abstract

Postoperative bile leaks are difficult to diagnose because signs and symptoms are nonspecific, and definitive diagnosis requires a drainage catheter to be placed that drains frank bile or fluid that turns out bile on laboratory analysis. Hepatobiliary scintigraphy, endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) have been traditionally used to diagnose bile leak. Scintigraphy has poor spatial resolution and cannot localize the site of leak, ERCP may not be possible with altered postoperative anatomy and PTC is invasive and difficult to perform in the absence of dilated ducts. Recently, contrast-enhanced MR cholangiography using hepatobiliary-specific contrast media has been shown to be a noninvasive, safe way to diagnose and localize the site of bile leak in adults. We report a case of postoperative bile leak after choledochal cyst resection in a child in whom diagnosis was confirmed and the site of leak was accurately localized using gadobenate-enhanced MR cholangiography. This case demonstrates the potential of hepatobiliary-specific contrast media to diagnose postoperative bile leak and accurately localize the site of the leak in children noninvasively.