Question:

Which of the following answer regarding endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) is false?
1. They provide anatomical and functional information.
2. They allow for treatment of bile duct injuries.
3. Possible complications of these procedures are severe acute pancreatitis, bleeding and cholangitis.
4. They can visualize extrabiliary abnormalities.
5. They are invasive and sometimes difficult to perform.





Answer:

The correct answer for the question "Which of the following answer regarding endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) is false?" is:

4. They can visualize extrabiliary abnormalities.



Explanation
1. They demonstrate the biliary anatomy and the presence of active leak by visualizing extravasation of contrast medium [Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) can identify a continuing bile leak and provide exact anatomical diagnosis.]

2. [ERCP and PTC allow for treatment of injury by appropriately decompressing or dilating the biliary tree.]

3. [These methods are invasive, use a considerable amount of X-rays and are associated with the risk of complications like severe acute pancreatitis (mainly after ERCP) bleeding and cholangitis (after PTC).]

4. The injected contrast medium opacifies and demonstrates only the biliary tree [other disadvantages include: lack of detection of extrabiliary abnormalities, nonvisualization of ducts upstream or downstream from an obstructing lesion (stricture, stone).]

5. [PTC could sometimes be technically difficult because intrahepatic bile ducts are usually not dilated.]



From the manuscript:
Bile leak after elective laparoscopic cholecystectomy: Role of MR imaging
Radiology Case. 2013 Jan; 7(1):25-32


This article belongs to the GI section.




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From the manuscript

Bile leak after elective laparoscopic cholecystectomy: Role of MR imaging

Free full text article: Bile leak after elective laparoscopic cholecystectomy: Role of MR imaging

Abstract
Increasing hepatobiliary laparoscopic surgeries have lead to a rise in injury to the biliary tree and other complications like bile leak. Ultrasonography (US) and computed tomography (CT) cannot reliably distinguish bile from other postoperative fluid collections. Magnetic resonance (MR) imaging with hepatobiliary agents and MR cholangiopancreatography provide anatomic and functional information that allows for prompt diagnosis and excludes any other concomitant complications. We report a case of post-cholecystectomy bile leak in a 42-year-old female who presented with persistent dull abdominal pain after the intervention; we emphasize the role of MR imaging in achieving the correct diagnosis.






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