Liver and Biliary System: Postoperative Findings

Abstract

Liver resection consists of the removal of a lobe or segment of the liver, and is usually followed by subsequent regeneration of the remnant parenchyma. Liver resection is mostly indicated not only in malignant tumors, but also in some benign liver conditions. Most of liver resections are “anatomical” which means that they are ruled by vascular landmarks such as portal and hepatic veins. Imaging, especially multiphasic CT, plays a major role in diagnosing and staging the liver disease, helping in surgical treatment planning, and in evaluating postoperative regeneration. CT is also crucial in the postoperative course for diagnosing complications. Most common complications are fluid collections (hematoma, biloma), and vascular complications. Postoperative imaging of the bile ducts is nowadays primarily based on non-invasive imaging modalities and invasive approach should be restricted to interventional procedures. CT scan has several advantages: complete overview of the abdomen, excellent vessels analysis, and pneumobilia depiction. Laparoscopic cholecystectomy is the most common biliary surgery, usually for acute or chronic calculous disease. Bile leakages are the most common complications, usually due to an incomplete cystic duct stump or to an injury because of an anatomical biliary duct variant. They may be revealed early with biliary collection, or lately with bile duct stenosis. Other common biliary surgical procedures are gallbladder resection and bile duct resection for cancer, inflammatory or traumatic lesions. Most early complications are biliary or enteric leaks or hemorrhage, all of them easily diagnosed by CT scan. Most late complications are secondary cholangitis due to stenosis, reflux, or dysfunction, for which CT plays an important role in assessing changes in liver morphology and searching vascular complications.