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Table 2 Checklist for the interpretation of early computed tomography (CT) after laparoscopic, converted and open cholecystectomy

From: Early cross-sectional imaging following open and laparoscopic cholecystectomy: a primer for radiologists

Feature Comments
Assess pleuropulmonary changes at lung bases Atelectasis/pneumonia/pleural effusion?
Scrutinise operated abdominal wall at (either) laparotomic incision or trocar access sites Wound haematoma?
Herniation of fat or viscera?
Fluid collection or abscess collections → suggest wound infection
Scrutinise peritoneal cavity Within a few days, mild residual air (particularly after laparotomy) and minimal fluid are expected findings
Significant peritoneal effusion → concern for bile leakage or (exceptional) visceral injury
Spilled gallstones?
Masses suspicious for retained surgical sponge?
Drainage tubes present? Mostly after converted and open cholecystectomy
Best visualised using thick-slab maximum intensity projection (MIP) reconstructions
Report presence, course and distal tip position
Scrutinise surgical bed Minimal fluid or blood at gallbladder fossa is normal
Common (non-infected) collections – measure size and attenuation
Abscess w/o spilled gallstones?
Haematoma?
Search for signs of bleeding Haematoma?
 - Usual site infrahepatic
 - Uncommon: haemoperitoneum, paraduodenal
Active haemorrhage (use MIP reconstructions + comparison between precontrast, arterial and portal venous phase)
Biliary tract status Intrahepatic bile ducts: diffuse/segmental dilatation?
Remnant cystic duct
Common bile duct: calibre, filling defects, position of clips
Abnormal findings → suggest magnetic resonance cholangiopancreatography (MRCP)
Assess splenic, portal and mesenteric veins Postoperative thrombosis? (most usually in septic patients)
Assess gastrointestinal tract Stomach and/or small bowel distension generally reflects ileus