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