[Utility of magnetic resonance cholangiography, ultrasonography and liver function test in preoperative assessment of patients with symptomatic cholecystolithiasis and suspected biliary obstruction [a comparative study]]

Evaluation of suspected biliary obstruction is performed by common old methods such as Ultrasound, CT, and invasive cholangiography. These techniques have limitations due to the poor visualization of intraductal stones [US, CT] and the need for an invasive procedure [ERCP, PTC]. Magnetic resonance cholangiography [MRC] is noninvasive imaging modality that provides good visualization of the hepatobiliary system. The aim of the present study was to determine the utility of Magnetic resonance cholangiography, Ultrasonography and Liver function test in preoperative assessment of patients with symptomatic cholecystolithiasis and suspected biliary obstruction. Patients selected for elective open cholecystectomy with risk factors of common bile duct stones as suspected biliary obstruction underwent MRC, US, and Liver function test preoperatively. All patients underwent open cholecystectomy and intraoperative cholangiography in Imam Khomeini Hospital, Academic Medical Center of Medicine School, Mazandaran University of Medical Sciences, Sari, Iran from January 2003 to February 2006. 30 patients [11 male, 19 female] with the mean age 53.93 +/- 13.32 years in a range of 38-75 years underwent all preoperative and operative assessments. 81.81% Sensitivity, 87.5% specificity and 83.33% efficacy in MRC; 18.18% Sensitivity, 87.5% specificity and 36.66% efficacy in US, and 54.54% Sensitivity, 37.50% specificity and 50% efficacy in Liver function test were the results obtained for biliary stones. MRC has excellent diagnostic accuracy in the detection of biliary disease. Due to its non-invasive nature, MRI may have advantages over invasive cholangiography when diagnosis is the major goal of the procedure

Ceftriaxone-associated biliary pseudolithiasis; a case report

Biliary sludge or pseudolithiasis has been reported in patients who have received prolonged and/high doses of ceftriaxone. These are usually asymptomatic, but true bililary lithiasis is also rare. In general these adverse effects [sludge and pseudolithiasis] may develop even after seven to ten days of treatment that are usually asymptomatic. We report a six half-year old girl that was admitted to the hospital due to urinary tract infection. She had been treated with ceftriaxone for 14 days. She developed biliary colic due to biliary lithiasis after 14-days treatment. Ultrasonography has reported high level echo with posterior shadow in gallbladder [true biliary stone]. We recommend patients on prolonged and high doses of ceftriaxone and also those developing biliary colic should be considered for liver and gallbladder ultrasound and changes in antibiotic treatment if necessary