Malrotation simulating gallbladder perforation on Tc-99M IDA scintigraphy. Pitfall to avoid.

A patient with upper abdominal discomfort had Tc-99m IDA scintigraphy performed for suspected gallbladder disease. In addition to filling of the bile ducts and the gallbladder, tracer collected in the right side of the abdomen and was thought at first to be the right paracolic gutter, indicating a gallbladder rupture. Discussion with the surgeon and radiographic correlation indicated that the patient did not have gallbladder perforation but, rather, a malrotation of the bowel. This diagnosis became clear on delayed images.