Radionuclide biliary scanning in acute pancreatitis.

Radionuclide biliary scanning with 99Tcm-labelled HIDA was performed in 36 patients with acute pancreatitis within 3 days of admission. Twenty had a non-visualized gallbladder on scanning and all were subsequently shown by cholecystography (n = 16) andlor operation (n = 16) to have underlying gallstones; 5 of the 16 cholecystograms revealed a ‘functioning’ gallbladder. Sixteen patients had normal HIDA scans with gallbladder visualization, and subsequently all were shown by cholecystography (n = 15) or operation (n = 1) to have a normal biliary tree; 15 of these had an alcoholic background. In the differentiation of gallstone from non-gallstone pancreatitis, biliary scanning was completely accurate and a better discriminant than the liver function profile or the clinical features, the latter being valueless. Whether or not the gallbladder is visualized on biliary scanning depends on the presence or absence of cystic duct obstruction, a fact confirmed in two other groups: in 53 patients with acute cholecystitis and non-visualized gallbladders on scanning, 52 were subsequently shown to have ‘non-functioning’ gallbladders by oral cholecystography (1 having stones in a functioning gallbladder), whereas 9 other patients with normal biliary scans, all had ‘functioning’ gallbladders on oral cholecystography. Thus, acute gallstone pancreatitis appears to be accompanied in the early stages by occlusion of the cystic duct, though this is a transient phenomenon in about one-third of the patients. The cause of this occlusion may be oedema in some cases but its relationship to the pathogenesis of acute pancreatitis is unclear.