A 62-year-old woman undergoes laparoscopic cholecystectomy for symptomatic gallstone disease. On postoperative day 2 she develops worsening right upper quadrant pain, fever, and rising bilirubin. A bile leak is suspected. Which investigation is most appropriate to confirm the diagnosis and localise the site of leak?

• A HIDA (hepatobiliary iminodiacetic acid) scintigraphy
• B MRCP (magnetic resonance cholangiopancreatography)
• C Ultrasound abdomen
• D ERCP (endoscopic retrograde cholangiopancreatography) ✓

Explanation

ERCP is both diagnostic and therapeutic for post-cholecystectomy bile leak: it identifies the site of leak (commonly the cystic duct stump or a duct of Luschka) and can be treated immediately with sphincterotomy and/or biliary stent placement to reduce ductal pressure and allow spontaneous closure. MRCP provides excellent anatomical imaging but is not therapeutic. HIDA scan can demonstrate bile leak but does not allow intervention. Ultrasound may show a perihepatic fluid collection (biloma) but cannot characterise the leak site precisely.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.