Biliary Findings on Magnetic Resonance Cholangiopancreatography in Patients with Post Cholecystectomy Pain

Abstract

Purpose: To find the incidence of different causes of post cholecystectomy pain on magnetic resonance cholangiopancreatography.Methodology: This is a prospective study of 74 patients with post-operative complain of post-cholecystectomy symptoms. Their ages ranged from 20 to 70 years. Patients with liver transplant were not included. MRCP was performed on 1.5 tesla GE machine at radiology department of our hospital. MRCP images were assessed for bile duct diameters and the presence of strictures and stones. A common bile duct (CBD) diameter of < 8mm was considered normal, whereas > or = 9mm was considered abnormal. Findings were correlated with LFTs and clinical findings.Results: Our results showed that 86.4%cases with post cholecystectomy pain had positive findings on MRCP. The commonest finding was biliary stones in 37.8 % cases. Post-cholecystectomy biliary complications included retained CBD stones in 28 patients (9 intrahepatic, 18 extra-hepatic and 1 in cystic duct stump), biliary duct injury in 4 patients (2 cases with biliary duct ligation and 2 cases with biliary leakage. Stricture was detected in distal CBD in 9, in CHD in 4 cases, at ampulla in 2, at hilum in 9 and in 9 at anastomotic site of choledochoeneterostomy site. In 10 of our cases, MRCP was negative for any finding. Conclusion:We conclude from our results that that 86.4%cases with post cholecystectomy pain had positive findings on MRCP and the most common cause of post cholecystectomy pain was biliary stones seen in 37.8%. The use of breath-hold 3D-SSFP MRCP is essential in evaluation of post-laparoscopic cholecystectomy biliary complications and in planning for management regimens.Recommendation: MRCP should be performed in patients with post cholecystectomy pain. If the CBD on ultrasound is > or = 10mm and no cause is identified, MRCP is necessary. However, the availability of LFTs raises the diagnostic value of imaging.