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Bile Leak From Gallbladder Perforation Mimicking Bowel Activity and a False-Negative Result in a Morphine-Augmented Cholescintigraphy

Department of Veterans Affairs Medical Center and University of Kentucky Medical Center, Lexington, Kentucky

Correspondence: For reprints or correspondence contact: Wei-Jen Shih, MD, Nuclear Medicine Service, Veterans Affairs Medical Center, Lexington, KY 40511.

ABSTRACT

Cholescintigraphy of a patient with bile leak demonstrated intra-abdominal activity that mimicked normal bowel activity. Because the gallbladder was not visualized, morphine was injected intravenously. Gallbladder activity after morphine injection was misleading in the finding of chronic cholecystitis. Concurrent abdominal sonography and computerized tomography revealed a thickened gallbladder wall with a gallstone and pericholecystic fluid collection. Exploratory laparotomy confirmed acute and chronic cholecystitis, cholelithiasis, choledocholithiasis, and a pericholecystic abscess. The false-negative conclusion for acute cholecystitis in the patient's morphine-augmented cholescintigraphy resulted from an acceleration of bile leakage due to pre-existing gallbladder perforation.