PMC6000772_01
MRCP showing probable CBD necrosis (RED ARROWS) with bilious ascites.
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CBD reduced to 6 mm diameter, resolved biliary ductal dilation, edema within the head of the pancreas, and no evidence of choledocholithiasis. Complex ascites was also now present in the upper abdomen and left paracolic gutter (Fig. 1).
A: Side by side comparison of axial slices of abdominopelvic computed tomography (CT A/P). Left image is admission CT scan, Right image is repeat CT after common bile duct perforation with new demonstration of ascites (WHITE ARROWS). B: Side by side comparison of coronal cuts of CT A/P. Left image from admission CT and Right image from repeat CT after perforation with ascites in lesser sac (WHITE ARROWS).
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There was no evidence of oral contrast extraluminal extravasation (Fig. 2A and B).
Selected images from hepatobiliary scintography. Left image showing initial tracer filing right and left hepatic ducts. Right image with extravasation of tracer into morrison's pouch (hepatorenal recess) and into the right paracolic gutter.
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Hepatobiliary scintography (Fig. 3) revealed tracer accumulation in the subhepatic and perihepatic spaces, indicating bile leak.