- Email: [email protected]
Diagnosis of bronchobiliary fistula using HIDA Scan – a report of two cases
e534
Electronic Poster Abstracts
Conclusions: Surgeons can increase their understanding of variant HA anatomy prior to embarking on foregut resections by studying representative 3D reconstructions alongside axial imaging.
EP04B-008 DIAGNOSIS OF BRONCHOBILIARY FISTULA USING HIDA SCAN e A REPORT OF TWO CASES B. M. Srinivasan, R. Vellaisamy, A. Anbalagan, P. Raju, B. Duraisamy, C. Servarayan Murugesan and K. Devy Gounder Institute of Surgical Gastroenterology, Madras Medical College, India Objectives: Bronchobiliary fistula is an abnormal communication between the biliary tree and airway. It presents with cough and bilioptysis. This article is to demonstrate the usefulness of HIDA scan in diagnosing bronchobiliary fistula. Methods: The study was between May 2013 and August 2015. Case 1: A 39 year male admitted with bilioptysis. He had earlier undergone PCD followed by laparotomy for ruptured liver abscess 2 years back. Within a month, relaparotomy was done with external drainage and cholecystostomy. Since he developed external biliary fistula then treated with fistulojejunostomy in 3rd surgery. Then patient developed bronchobiliary fistula which was demonstrated by HIDA scan and not by MRCP. He was then treated with ERCP and biliary stenting. Bilioptysis stopped in 10 days. Case 2: A 35 year male, hilar cholangiocarcinoma with liver metastasis admitted with bilioptysis for 20 days. He had undergone palliative PTBD with stent internalisation 4 months back. The bronchobiliary fistula was then demonstrated by HIDA scan. He was treated with ERCP and biliary stenting. The bilioptysis stopped in 7 days results in both the patients MRCP failed to diagnose the fistulous communication which are well diagnosed with HIDA scan. Conclusion: Bronchobiliary fistula has to be suspected in patients with bilioptysis who have undergone hepatobiliary intervention. Diagnosing fistula may be difficult with MRCP and other imaging modalities. But with HIDA scan it is possible to diagnose the bronchobiliary fistula as is evident from these cases, which will be helpful for the management.
EP04B-009 ENDOSCOPIC ULTRASONOGRAPHY AND COMPUTER TOMOGRAPHY: TUMOR SIZE CORRELATION COMPARED WITH HISTOPATHOLOGY REPORT M. Rodriguez Lopez, M. Bailon Cuadrado, B. Pérez Saborido, R. Velasco Lopez, S. Mambrilla Herrero, F. J. Tejero Pintor, E. Asensio Diaz, L. M. Diez Gonzalez, D. Pacheco Sanchez, P. Pinto Fuentes and A. Barrera Rebollo General and Digestive Surgery, Rio-Hortega University Hospital, Spain
Introduction: Accurate imaging diagnosis remains of high importance in pancreatic and periampullary malignancies. Computer tomography (CT) and endoscopic ultrasonography (EUS) have a key role. Since pancreatic resection is the cornerstone of treatment for these tumors, imaging should offer a tumor size correlation with histopathology (HP) report as high as possible. Methods: Retrospective analysis of all resected pancreatic and periampullary lesions malignancies in our HPB Surgery Unit (Rio-Hortega University Hospital, Valladolid, Spain) from January 2012 to December 2014. Inclusion criteria: reported tumor size in both preoperative EUS and CT as well as specimen histopathology (HP). We compared tumor size among these three and established a Pearson correlation. Pancreatic and ampullary adenocarcinoma has been defined as subgroups. Statistical analysis SPSS 18.0. Results: 86 patients underwent operation of whom 31 (36%) were included for analysis (ratio male-female 1:1, age: 62.6 11.7 years). Tumor size in USE: 26.46 10.82 mm. Tumor size in CT: 26.29 12.08 mm. Tumor size in HP: 29.65 13.43 mm. HP diagnosis: pancreatic adenocarcinoma (61.3%), ampullary adenocarcinoma (22.6%), duodenal adenocarcinoma (6.5%), intrapancreatic cholangiocarcinoma (6.5%), G3 neuroendocrine tumor (3.2%). Correlation between HP, EUS and CT tumor size in the whole series and in subgroups is shown in Table 1. Table 1
Correlation between HP and EUS
Correlation between HP and CT
Whole series
r = 0.28 (n.s.)
r = 0.57 (p = 0.007)
Pancreatic adenocarcinoma
r = 0.24 (n.s.)
r = 0.65 (p = 0.009)
Ampullary adenocarcinoma
r = 0.58 (n.s.)
r = 0.56 (n.s.)
Conclusions: Tumor size measure has not been widely reported nor in our preoperative imaging neither in HP report. CT scan appears to be superior to EUS for correlating tumor size with HP, though this correlation is not strong. After subgroup analysis of the most frequent HP types, this finding only is obtained for pancreatic adenocarcinoma.
EP04B-011 FUNCTIONAL STATE OF STOMACH AND SMALL BOWEL AFTER PANCREATIC RESECTIONS A. Shabunin1,2, V. Bedin1,2, M. Tavobilov1,2, D. Grekov1,2, A. Karpov1,2 and P. Drozdov1 1 HPB, Botkin City Clinical Hospital, and 2Russian Medical Academy of Postgraduate Study, Russian Federation Objective: To identify the physiological characteristics of the gastric emptying, the presence of different types of reflux. Materials and methods: Assessment was performed in the two-detector gamma camera with dual intravenous injection 120 MBq isotope technetium Tc-99 m and orally ingestion of 10% semolina labeled with 40 MBq Tc-99 m. The first study was performed on the preoperative stage. The second-at 13e16 POD, depending on its severity and HPB 2016, 18 (S1), e385ee601
Electronic Poster Abstracts
Conclusions: Surgeons can increase their understanding of variant HA anatomy prior to embarking on foregut resections by studying representative 3D reconstructions alongside axial imaging.
EP04B-008 DIAGNOSIS OF BRONCHOBILIARY FISTULA USING HIDA SCAN e A REPORT OF TWO CASES B. M. Srinivasan, R. Vellaisamy, A. Anbalagan, P. Raju, B. Duraisamy, C. Servarayan Murugesan and K. Devy Gounder Institute of Surgical Gastroenterology, Madras Medical College, India Objectives: Bronchobiliary fistula is an abnormal communication between the biliary tree and airway. It presents with cough and bilioptysis. This article is to demonstrate the usefulness of HIDA scan in diagnosing bronchobiliary fistula. Methods: The study was between May 2013 and August 2015. Case 1: A 39 year male admitted with bilioptysis. He had earlier undergone PCD followed by laparotomy for ruptured liver abscess 2 years back. Within a month, relaparotomy was done with external drainage and cholecystostomy. Since he developed external biliary fistula then treated with fistulojejunostomy in 3rd surgery. Then patient developed bronchobiliary fistula which was demonstrated by HIDA scan and not by MRCP. He was then treated with ERCP and biliary stenting. Bilioptysis stopped in 10 days. Case 2: A 35 year male, hilar cholangiocarcinoma with liver metastasis admitted with bilioptysis for 20 days. He had undergone palliative PTBD with stent internalisation 4 months back. The bronchobiliary fistula was then demonstrated by HIDA scan. He was treated with ERCP and biliary stenting. The bilioptysis stopped in 7 days results in both the patients MRCP failed to diagnose the fistulous communication which are well diagnosed with HIDA scan. Conclusion: Bronchobiliary fistula has to be suspected in patients with bilioptysis who have undergone hepatobiliary intervention. Diagnosing fistula may be difficult with MRCP and other imaging modalities. But with HIDA scan it is possible to diagnose the bronchobiliary fistula as is evident from these cases, which will be helpful for the management.
EP04B-009 ENDOSCOPIC ULTRASONOGRAPHY AND COMPUTER TOMOGRAPHY: TUMOR SIZE CORRELATION COMPARED WITH HISTOPATHOLOGY REPORT M. Rodriguez Lopez, M. Bailon Cuadrado, B. Pérez Saborido, R. Velasco Lopez, S. Mambrilla Herrero, F. J. Tejero Pintor, E. Asensio Diaz, L. M. Diez Gonzalez, D. Pacheco Sanchez, P. Pinto Fuentes and A. Barrera Rebollo General and Digestive Surgery, Rio-Hortega University Hospital, Spain
Introduction: Accurate imaging diagnosis remains of high importance in pancreatic and periampullary malignancies. Computer tomography (CT) and endoscopic ultrasonography (EUS) have a key role. Since pancreatic resection is the cornerstone of treatment for these tumors, imaging should offer a tumor size correlation with histopathology (HP) report as high as possible. Methods: Retrospective analysis of all resected pancreatic and periampullary lesions malignancies in our HPB Surgery Unit (Rio-Hortega University Hospital, Valladolid, Spain) from January 2012 to December 2014. Inclusion criteria: reported tumor size in both preoperative EUS and CT as well as specimen histopathology (HP). We compared tumor size among these three and established a Pearson correlation. Pancreatic and ampullary adenocarcinoma has been defined as subgroups. Statistical analysis SPSS 18.0. Results: 86 patients underwent operation of whom 31 (36%) were included for analysis (ratio male-female 1:1, age: 62.6 11.7 years). Tumor size in USE: 26.46 10.82 mm. Tumor size in CT: 26.29 12.08 mm. Tumor size in HP: 29.65 13.43 mm. HP diagnosis: pancreatic adenocarcinoma (61.3%), ampullary adenocarcinoma (22.6%), duodenal adenocarcinoma (6.5%), intrapancreatic cholangiocarcinoma (6.5%), G3 neuroendocrine tumor (3.2%). Correlation between HP, EUS and CT tumor size in the whole series and in subgroups is shown in Table 1. Table 1
Correlation between HP and EUS
Correlation between HP and CT
Whole series
r = 0.28 (n.s.)
r = 0.57 (p = 0.007)
Pancreatic adenocarcinoma
r = 0.24 (n.s.)
r = 0.65 (p = 0.009)
Ampullary adenocarcinoma
r = 0.58 (n.s.)
r = 0.56 (n.s.)
Conclusions: Tumor size measure has not been widely reported nor in our preoperative imaging neither in HP report. CT scan appears to be superior to EUS for correlating tumor size with HP, though this correlation is not strong. After subgroup analysis of the most frequent HP types, this finding only is obtained for pancreatic adenocarcinoma.
EP04B-011 FUNCTIONAL STATE OF STOMACH AND SMALL BOWEL AFTER PANCREATIC RESECTIONS A. Shabunin1,2, V. Bedin1,2, M. Tavobilov1,2, D. Grekov1,2, A. Karpov1,2 and P. Drozdov1 1 HPB, Botkin City Clinical Hospital, and 2Russian Medical Academy of Postgraduate Study, Russian Federation Objective: To identify the physiological characteristics of the gastric emptying, the presence of different types of reflux. Materials and methods: Assessment was performed in the two-detector gamma camera with dual intravenous injection 120 MBq isotope technetium Tc-99 m and orally ingestion of 10% semolina labeled with 40 MBq Tc-99 m. The first study was performed on the preoperative stage. The second-at 13e16 POD, depending on its severity and HPB 2016, 18 (S1), e385ee601