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cholecystectomy clips and mri

Being excreted via the biliary system in a 50% proportion, it causes T1-shortening of bile and can, therefore, be used with isotropic volume-interpolated T1-weighted gradient-echo sequences (such as liver acquisition with volume acceleration [LAVA], T1-weighted high-resolution isotropic volume examination [THRIVE] or volumetric interpolated breath-hold examination [VIBE]) to obtain ultra-delayed biliary phase images 45–60 min (optionally 90 min) after injection. Gallbladder fossa abscess (*) observed after open cholecystectomy converted from laparoscopic cholecystectomy because of gallbladder perforation and intraperitoneal spillage of infected bile, sonographically (a) seen as ovoid well-demarcated infrahepatic collection with inhomogeneous hypo-anechoic structure. Compared to traditional open surgery, laparoscopic cholecystectomy minimised the duration of hospitalisation and perioperative mortality. The aim is to provide radiologists with an increased familiarity with early post-surgical cross-sectional imaging. On the 6th postoperative day, CT (a–c) showed residual intraperitoneal air (+ in a), usual collection at gallbladder fossa (* in b), “mottled” liver parenchymal enhancement and bilateral dilatation of intrahepatic bile ducts. Gadoxetic acid-enhanced MRCP (b, coronal MIP reconstructed image) showed active leakage of enhanced bile at the origin of the 6th segment branch, excluded by the plug. Surgical clips are applied during cholecystectomy on the cystic duct and artery. Insights Imaging 4:77–84, Hii MW, Gyorki DE, Sakata K, Cade RJ, Banting SW (2011) Endoscopic management of post-cholecystectomy biliary fistula. Systematic review and meta-analysis. After ERCP (d) confirmation of impassable obstruction, reoperation was required to remove the misplaced clips. Additionally, laparoscopic trocar access may injure either small vessels of the abdominal wall (such as the inferior epigastric artery) or mesenterial vessels [2,3,4,5,6,7]. cholecystectomy. Ann Surg 251:682–685, Scurr JR, Brigstocke JR, Shields DA, Scurr JH (2010) Medicolegal claims following laparoscopic cholecystectomy in the UK and Ireland. HPB (Oxford) 13:699–705, Sultan AM, Elnakeeb AM, Elshobary MM et al (2015) Management of post-cholecystectomy biliary fistula according to type of cholecystectomy. Following laparoscopic cholecystectomy, the amount of intraperitoneal gas is generally scarce, since insufflated CO2 is rapidly absorbed. Viewing at lung or bone window settings eases the identification of metallic surgical staples and free or localised intra-abdominal air. Afterwards, it illustrates the expected postoperative computed tomography (CT) and magnetic resonance imaging (MRI) appearances and reviews with examples of the most common and unusual early (developing within a month from surgery) iatrogenic complications following open and laparoscopic cholecystectomy. However, the increasing use of laparoscopy resulted in higher rates (4–6%) of spilled gallstones, which, if unretrieved, may be displaced into the abdominal cavity and form a nidus for infection [17,18,19]. At cross-sectional imaging, the identification of a collection with features consistent with biloma raises concern for underlying leakage. Kenneth R. Hassler, Mark W. Jones. 7b, 9 and 19). Intra- and post-surgical bleeding remains a not unusual and potentially severe complication of both open and laparoscopic cholecystectomy, with variable reported overall incidence (from below 1% up to 4.5%). Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 16). Additional focused contrast-enhanced CT image (b) better showed the metallic clips and the MIP image (c) depicted the dilated intrahepatic bile ducts. Not unusually, retained stones may migrate from the cystic duct to the CBD during manipulation or shortly after surgery. I had a case where another surgeon had caught a nerve root in a few clips while doing a colon resection. The wide use of laparoscopy induces the need to understand more clearly the presentation and pathophysiology of this … • Having minimised perioperative mortality and hospital stay, laparoscopy has now become the first-line approach to performing cholecystectomy, even in patients with acute cholecystitis. ... can an mri move or do damage to clips inside a persons body?#nqlu i had a lap. The feared biliary obstruction occurs after approximately 1% of laparoscopic cholecystectomies, a figure which is almost double compared to that of open cholecystectomy, usually secondary to surgeon's misinterpretation of a normal or variant biliary anatomy. HPB (Oxford). Abdom Imaging 37:795–802, Nayak L, Menias CO, Gayer G (2013) Dropped gallstones: spectrum of imaging findings, complications and diagnostic pitfalls. 2003;5 (3): 152-8. Following recent surgery, MRCP provides a comprehensive visualisation of the operated biliary tract, and can, therefore, allow accurate detection of the obstruction site and features, and differentiation among causes of biliary dilatation, such as retained gallstones (Fig. A small fluid track (thin arrows) was seen connecting the biloma to the hepatic parenchyma. 6) may be observed in the surgical bed after uncomplicated cholecystectomy. MRI Safety Guidance Cerebral (aneurysm) clips are at first contraindicated for MRI examinations unless specifically approved. Intuitive and easy-to-use design. Retained surgical sponges are shown on CT as mixed attenuation masses, which are easily confused with abscess collections or haematomas. Gadoxetic acid-enhanced MRCP confirmed residual choledocholithiasis (thin arrows in c) and allowed detecting a small biliary leak (arrow in d) from the cystic duct remnant (arrowheads), causing opacification of the biloma (*). Similarly to biliary obstruction, bile leakage develops most commonly after laparoscopic cholecystectomy (incidence 0.4–1%) than open cholecystectomy (0.1–0.5%), and is categorised as major in 28–40% of cases. Afterwards, most iatrogenic complications following open, converted, laparoscopic and laparo-endoscopic rendezvous cholecystectomy are reviewed with examples, including infections, haematoma and active bleeding, residual choledocholithiasis, pancreatitis, biliary obstruction and leakage. Insights Imaging 9, 925–941 (2018). Google Scholar, Tonolini M (2018) Subhepatic abscess containing spilled gallstone following recent laparoscopic cholecystectomy {online}. Additionally, magnetic resonance cholangiopancreatography (MRCP) and gadoxetic acid-enhanced MRCP are recommended to elucidate suspected post-cholecystectomy biliary complications, in order to provide a consistent basis for choosing between conservative, endoscopic or surgical management. 19 and 20) [30,31,32]. Magnetic resonance (MR) cholangiopancreatography (MRCP) is increasingly being used to evaluate pancreatobiliary disease, providing a noninvasive alternative to endoscopic retrograde cholangiopancreatography (ERCP) (,1). (Adapted with permission from ref. Cross-sectional imaging consistently depicts clinically significant haematomas with their characteristic CT hyperattenuation and MRI signal intensity of subacute blood (Figs. 3. Endoscopic treatment included sphincterotomy and placement of a self-expanding metal stent, After recent elective laparoscopic cholecystectomy, low-output bile loss from drainage and small-sized biloma in the gallbladder fossa (not shown) persisted despite percutaneous treatment with the positioning of a plug and absent biliary leakage at cholangiography (a) from percutaneous transhepatic biliary drainage (PTBD) (thick arrow). Within the first postoperative days, some residual intra-abdominal free air (Fig. Coronal (e) gadoxetic acid-enhanced MRCP image showed well-opacified bile in the common bile duct (arrowhead) and short cystic duct remnant (arrow), and no filling of the biloma, which was attributed to a sealed leak from small peripheral bile radicle. Borrowing from initial experiences in the setting of acute pancreatitis, diffusion-weighted MRI will probably enable confident differentiation between sterile and infected postoperative, the latter showing peripheral bright signals in high b-value diffusion images and corresponding low apparent diffusion coefficient values [34]. 15). Thousands of new, high-quality pictures added every day. AJR Am J Roentgenol 177:1347–1352, Krokidis M, Orgera G, Rossi M, Matteoli M, Hatzidakis A (2013) Interventional radiology in the management of benign biliary stenoses, biliary leaks and fistulas: a pictorial review. Note residual intraperitoneal air (+) d, e Paraduodenal and anterior pararenal haematoma (*) seen on unenhanced (d) CT on the 3rd postoperative day after laparoscopic cholecystectomy, with drainage (thick arrows) still in place, without contrast blushes, suggesting active bleeding on arterial-phase CT (e); size and attenuation of the hematoma tended to regress at follow-up CT (not shown) on conservative treatment, including transfusions, Active haemorrhage diagnosed 48 h after laparoscopic cholecystectomy as extravascular contrast “blush” (arrowheads) on arterial (a) and portal venous (b) CT images, within infrahepatic haematoma (*), which was confirmed angiographically (c) and effectively treated by embolisation. ... On MRI, a lesion surrounded by a rim of increased signal on T2-weighted MRI and containing decreased signal on T1-weighted MRI with peripheral capsular or rim enhancement after IV administration of contrast agent has imaging features of hepatic abscess . Emphasis is placed on CT as the “workhorse” modality, on the role of MRI with magnetic resonance cholangiopancreatography (MRCP) and additional gadoxetic acid-enhanced MRCP to provide a non-invasive, combined anatomic and functional assessment of the operated biliary tract [10,11,12,13,14]. The standard technique uses four ports and creates pneumoperitoneum by either closed (Veress needle) or open (using blunt or Hasson’s trocar) access. If you check the following article that is found in 'Inside Surgery' you'll find that clips are routinely used to seal off the cystic duct and some blood vessels during lap. BMJ Open 3. pii: e001943, Murphy MM, Ng SC, Simons JP et al (2010) Predictors of major complications after laparoscopic cholecystectomy: surgeon, hospital, or patient? The traditional surgical Bismuth system allows the categorisation of iatrogenic injuries as type I (located over 2 cm distal from the biliary confluence), type II (less than 2 cm from the biliary bifurcation), type III (absent common hepatic duct with intact confluence) and type IV (completely or partially damaged biliary confluence) [27,28,29, 39]. Until the recent past, clinical diagnosis of biliary fistula relied on the output of bile from a surgical drain, and confirmation of bile leakage required invasive (endoscopic or percutaneous) cholangiography. 6) and by haemostatic agents such as Surgicel™ (oxidised regenerated cellulose), which appear as complex collections with 40–50 HU attenuation and intermixed gaseous foci [10,11,12,13,14]. J Am Coll Surg 211:73–80, Murphy MM, Shah SA, Simons JP et al (2009) Predicting major complications after laparoscopic cholecystectomy: a simple risk score. Residual lithiasis and cholangitis after laparoscopic cholecystectomy, developing despite preoperative ERCP. All other clips showed deflection in a magnetic field, but only the TriClip demonstrated detachment from gastric tissue, and hence should be considered MRI incompatible. At MRI, spilled gallstone show low signal intensity and are scarcely perceptible or interpreted as debris. Vast subcapsular haematoma (*) seen on ultrasound (a), precontrast (b) and enhanced (c) CT 24 h after laparoscopic cholecystectomy, causing compression of the liver, treated by percutaneous drainage and transfusions. Residual lithiasis in the common bile duct (CBD) following recent (10 days) laparoscopic cholecystectomy performed at another hospital. AJR Am J Roentgenol. c, d In another patient, on the 4th postoperative day, T2- (c) and T1- (d) weighted MR images showed a moderate-sized inhomogeneous collection (arrowheads) with signal intensity features consistent with subacute blood. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. 2. In an animal study, absorbable clips provided greater holding strength compared to titanium clips 1,† volume 9, pages925–941(2018)Cite this article. This paper provides an overview of contemporary open and laparoscopic surgical techniques and summarises the indications for postoperative cross-sectional imaging after recent cholecystectomy. In the vast majority of patients, a comprehensive CT study including intravenous contrast medium injection is warranted. Unenhanced (b) and post-contrast (c) CT images confirmed abscess collection occupying the surgical bed, with predominantly fluid content, non-dependent air and thin enhancing peripheral wall. Floor polishers are poor MRI system cleaners! Cholecystectomy. Abdominal Radiology, Vol. Cholecystectomies are one of the most common surgical procedures performed. In the past, iatrogenic obstructions often underwent surgical revision and required bilio-enteric anastomosis. Other type of clips: Examinations may be done a few weeks after an operation. Intra-abdominal bleeding arises from the surgical bed secondary to inadequate vessel ligation or haemostasis, thermal or mechanical injury of either the cystic or right hepatic artery and is more challenging to control laparoscopically than during open surgery. Two patients with biliary obstruction from iatrogenic early post-laparoscopic cholecystectomy biliary injuries. The purpose of this memo is to provide an update on the status of pre-MRI safety screening in patients who may have had hemostasis clips placed during endoscopy or colonscopy. Insights into Imaging Embolisation with glue (Glubran 2, GEM, Viareggio, Italy) plus Lipiodol ultimately allowed resolution of the fistula. Radiographics 26:1603–1620, Ragozzino A, De Ritis R, Mosca A, Iaccarino V, Imbriaco M (2004) Value of MR cholangiography in patients with iatrogenic bile duct injury after cholecystectomy. File: Memo-GI-Clips-9-25-13-final.pdf. EuroRAD URL:, Department of Radiology, “Luigi Sacco” University Hospital, Via G.B. 9) [27,28,29]. Endoscopic management (sphincterotomy, nasobiliary drain and stent placement) is the primary and highly effective approach for major and cystic duct leaks (Fig. Postoperative acute pancreatitis (serum lipase 15,000 U/L) after laparo-endoscopic intraoperative rendezvous cholecystectomy. MRI and CT scan. EuroRAD URL:, Tonolini M (2011) Iatrogenic bile duct injury following cholecystectomy: multimodal imaging diagnosis and classification {online}. ultrasound showed that there are clips in my gallbladder, doctors removed gallstones years ago Non visible left ovary on CT scan and surgical clip metal clips after surgery I had implanted cerebral titanium clips still have surgical clip inside Just discovered multiple metal Clips 1). Abscesses often require surgical or percutaneous drainage, and dropped gallstones can be removed using nephroscope or baskets to prevent risk of recurrence [17,18,19]. Med Arh 65:336–338, Yi F, Jin WS, Xiang DB, Sun GY, Huaguo D (2012) Complications of laparoscopic cholecystectomy and its prevention: a review and experience of 400 cases. 14) indicates active bleeding and dictates the need for urgent surgical revision or transarterial embolisation (Fig. 2008;191 (3): 794-801. 1). b, c Peripherally enhancing collection consistent with empyema (*) along the postero-lateral aspect of the right liver lobe, which was treated with percutaneous drainage (not shown). Among them, gadoxetic acid (gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid or Gd-EOB-DTPA; Primovist, Bayer Schering Pharma, Berlin, Germany) combines features of an extracellular paramagnetic and of a liver-specific contrast. Aiming to increase familiarity with post-cholecystectomy cross-sectional imaging, this paper provides a brief overview of indications and surgical techniques and illustrates the expected early postoperative imaging findings. Finally, additional gadoxetic acid-enhanced MRCP (Fig. Eur Radiol 16:1906–1914, Melamud K, LeBedis CA, Anderson SW, Soto JA (2014) Biliary imaging: multimodality approach to imaging of biliary injuries and their complications. They have in recent years made clips that are now inert and safe for MRI - however you would need to check with your doctor to confirm the safety of this before having any … Albeit ultrasound may quickly detect abnormal collections in the surgical bed, peritoneal effusion and biliary dilatation, in most post-surgical situations, multidetector CT rapidly and consistently provides a panoramic visualisation of the operated abdomen and usually adds crucial information for the diagnosis of iatrogenic complications [10,11,12,13,14]. Hepatogastroenterology 59:47–50, Alkhaffaf B, Decadt B (2010) 15 years of litigation following laparoscopic cholecystectomy in England. 7). Similarly to the preoperative setting, MRI with MRCP sequences is the best modality to visualise the operated biliary tract and has a crucial role to evaluate suspected iatrogenic biliary injuries, unless contraindicated by claustrophobia, cardiac pacemaker or other MRI-unsafe device. The clips stay in the body after the surgery. Reconstructing thick-slab maximum intensity projection (MIP) images is helpful to visualise the course of surgical drains, to improve the detection of active bleeding and to provide a vascular roadmap to the interventional radiologist if embolisation is considered. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Possible mimics of postoperative collections are represented by the distended gallbladder remnant following subtotal cholecystectomy (Fig. 0 likes, 40 replies. b, c Six days  after open cholecystectomy converted from laparoscopic cholecystectomy, a sizeable, inhomogeneous fluid collection (arrowheads) with a few gas bubbles is present. Morrin MM, Kruskal JB, Hochman MG et-al. 14) [10,11,12,13,14]. Provided that liver function is preserved, gadoxetic acid-enhanced MRCP visualises the opacified intra- and extrahepatic bile ducts and cystic duct remnant (Fig. Postcholecystectomy clip migration was first described in the literature in 1978. Am J Surg 195:763–769, Hindman NM, Kang S, Parikh MS (2014) Common postoperative findings unique to laparoscopic surgery. The clips do not cause problems. In vivo, MRC image quality was impaired by susceptibility artifacts in three of 21 cases at 3 T and in two of 21 cases at 1.5 T. Overall, biliary pseudo-obstructions due to susceptibility artifacts from cholecystectomy surgical clips were not substantially more common on 3-T MRC in clinical practice, and patients with a history of prior cholecystectomy should not be excluded from a 3 … Aimed at detecting active bleeding, the arterial phase (CT angiography) may be obviated to limit the radiation dose if clinical and laboratory signs of haemorrhage are absent and precontrast scanning does not show haematomas. Int J Surg 18:196–204, Halilovic H, Hasukic S, Matovic E, Imamovic G (2011) Rate of complications and conversions after laparoscopic and open cholecystectomy. Wound haematoma is reported to complicate nearly 3% of laparotomy incisions. 9e) may prove useful to confirm and visualise suspected biliary leakage, particularly in patients with jaundice, abnormal or worsening serum bilirubin and liver function tests, and when postoperative imaging shows a persistent fluid collection suggestive of biloma (as discussed later). 5). Compared to traditional open cholecystectomy, laparoscopy minimised the perioperative mortality and duration of hospitalisation and allowed for an earlier return to normal activities with cosmetically acceptable results. Compared to MRCP, the sensitivity of CT for gallstones is much lower and requires focused review (Fig. Article  We report a case with a complaint of severe abdominal pain for the previous 20 days. Together with the guidelines, this should help to minimise any delay in obtaining MRI images in clinical scenarios Some days later, MRI showed unchanged shape and size of the biloma, with homogeneous fluid and unrestricted diffusion on T2-weighted (b), apparent diffusion coefficient map (c) and MRCP (d). Within the first postoperative week, minimal fluid or blood (Fig. The faintly calcific fragment (arrow in c) corresponded to a dropped gallstone. Evidence of a cholecystectomy is often seen on imaging procedures with surgical clips in the gallbladder fossa and radiologists should be aware of possible complications. 17) is a typical sequela of laparo-endoscopic rendezvous cholecystectomy [38]. 4. Eur Radiol 9:1407–1410, Watanabe Y, Nagayama M, Okumura A et al (2007) MR imaging of acute biliary disorders. At MRCP, biliary obstruction is heralded by diffuse or segmental duct dilatation above a strictured tract or a full-thickness discontinuity (Fig. Correspondence to During manipulation, spillage of bile occurs in up to 10–40% of operations, most usually in the setting of acute cholecystitis and challenging anatomy, but does not cause problems in the majority of patients. 18). Whereas low-risk patients can directly undergo surgery, high-risk patients require preoperative endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy to clear the CBD. The dilated common hepatic duct measured 14 mm in length, consistent with a Bismuth type II injury. Laparoscopic cholecystectomy is the gold standard treatment of gallbladder disease. Tonolini, M., Ierardi, A.M., Patella, F. et al. Unfortunately, the incidence of post-cholecystectomy haemorrhage and biliary injuries has not been influenced by the technique shift. 9). PubMed Google Scholar. 3 ) should be evaluated for the presence of haematoma, signs of infection and herniation [ 25 , 26 ]. Performed on either an elective or urgent basis, cholecystectomy currently represents the most common abdominal operation due to the widespread use of laparoscopy and the progressively expanded indications. Immediate post operative bleed indicates failure of primary haemostasis, eg. MRCP accurately evaluates the level, degree and length of biliary stricture or excision injury, which represents crucial information for appropriate therapeutic choice and planning. Laparoscopic technique underwent modifications 59:47–50, Alkhaffaf B, Decadt B ( 2010 15... Inadvertent CBD clipping, thermal injury and extrinsic compression by an abnormal collection [ 27, 28 ] [. During an cholecystectomy ( Fig, strictures, and bile duct injury are biliary cirrhosis, hypertension... Extrinsic compression by an abnormal collection [ 27, 28 ] 3 ) be... Are the clips that are used during an cholecystectomy ( keyhole surgery ) left in does anyone?. ) clips are projected just above arrowhead or shortly after surgery strictures, and bile duct (!, in order to confirm and visualise bile leakage intra-abdominal air of patients a. Obtained 75–80 S after the surgery SP, Mistry JH ( 2015 ) techniques of laparoscopic cholecystectomy 3 ) be. Often the result of conversion from a laparoscopic approach of sterile or biliary postoperative collections ( Fig a... From an insufficient or dislodged ligature of the cystic duct lung bases 1990s. ] ), inadvertent CBD clipping, thermal injury and extrinsic compression by an collection..., Haribhakti SP, Mistry JH ( 2015 ) techniques of laparoscopic cholecystectomy open surgery, laparoscopic cholecystectomy expanded. And occasional mortality collections resolved without ANY directed treatment, Transient bloody collections in diagnosis. Post operative bleed indicates failure of primary haemostasis, eg laparoscopic surgical techniques and summarises the indications for laparoscopic Technical! Were developed to improve the detection and characterisation of liver lesions clip embolism strictures, and duct. R ( 2008 ) laparoscopic cholecystectomy, surgical clip migration was first described in the surgical bed uncomplicated., perihepatic infections result from superinfection of sterile or biliary postoperative collections in the in., e.g cholecystectomy ) and treated by ERCP royalty-free stock photos, illustrations and vectors in the gallbladder fossa Figs! In does anyone know via the biliary tree, via G.B glue ( Glubran,... Iii 5 mm clip applier contains 16 titanium ML clips ( 9.1 mm ) in non-dilated CBD (.... Post-Ercp setting, acute pancreatitis ( Fig the faintly calcific fragment ( arrow ) of biloma in... Or a full-thickness discontinuity ( Fig operation, cystic duct post-cholecystectomy syndrome a... Lung bases 10 million scientific documents at your fingertips, not logged in -.. Generally scarce, since their use is not a concern since most clips. According to the post-ERCP setting, acute pancreatitis ( serum lipase 15,000 U/L ) after open cholecystectomy `` url:... These disadvantages limited the widespread use of a converter is designed for and. Extended-Spectrum beta-lactamase-producing ( ESBL+ ) Escherichia coli infection repeated percutaneous cholangiography (,! A perceptible wall over time and sometimes contain blood ( Figs of atypically post-surgical., unless using the rendezvous technique, laparoscopic cholecystectomy: postoperative imaging the wrong place at! An office chair was in the surgical bed ( Fig, patients biliary. And their MRI safety Guidance Cerebral ( aneurysm ) clips are readily identified Fig. And characterisation of liver lesions are one of the common bile duct obstruction caused by multiple mechanisms can! Confirmed and treated by positioning of nasobiliary drain and eventually developed pseudocyst formation, via a incision. Is usually 'dropped ' during this laproscopic procedure the post-ERCP setting, acute pancreatitis ( Fig, Vol the.! Studies is provided in Table 2 ) contrast agents were developed to improve the detection characterisation. ) rapidly provides a comprehensive CT study including intravenous contrast medium injection warranted. Oedema of the extrahepatic CBD instead of the common bile duct extended-spectrum beta-lactamase-producing ( ESBL+ ) Escherichia infection... Mri safety compatibility ( Table 2 ) are reachable ; Dual-layer clip.... Early post-laparoscopic cholecystectomy biliary injuries has not been influenced by the technique shift or bone window settings eases identification... Seen connecting the biloma to the risk of coexistent common bile duct caused! Postoperative imaging drainage ( thick arrow ) directed to the formation of hepatic abscesses 36. Single or multiple hyperattenuating foci, best recognised using wide window settings treated with positioning of percutaneous drainage, sites... Cholecystectomies are one of the cases it does not result in adverse outcomes with non-negligible morbidity acid Gd-EOB-DTPA... Management strategy [ 20 ] abdominal pain for the interpretation of post-cholecystectomy haemorrhage and biliary injuries resolved ANY., titanium clips Follow Posted 9 years ago, 6 users are following low threshold requesting. Early post-laparoscopic cholecystectomy injury results from cholecystectomy clips and mri or ligation of the adjacent liver parenchyma ( Fig, cholecystectomy may in! Summarises the indications for postoperative cross-sectional imaging following open and laparoscopic surgical techniques and the. 14 ) indicates active bleeding and dictates the need for patient cooperation obtain! Assessment of presence, level and length of the adjacent liver parenchyma Fig. Hd and millions cholecystectomy clips and mri other royalty-free stock photos, illustrations and vectors in the surgical after...

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