Biliary complications of surgical procedures: what the radiologist needs to know

Post-surgical biliary complications increase morbidity, mortality, and healthcare utilization. Early detection and management of biliary complications is thus of great clinical importance. Even though the overall risk for biliary complications is low after laparoscopic cholecystectomy, post-cholecystectomy biliary complications are frequently encountered in clinical practice as laparoscopic cholecystectomy is the most common surgical procedure performed in the United States. Other surgical procedures fraught with biliary complications include liver transplantation, pancreaticoduodenectomy, hepatic resection, and gastric surgeries. The clinical presentation of biliary complications is variable; imaging, thus, plays a vital role in diagnosis and management. Biliary leak (BL) and stricture are the most common biliary complications. Although Ultrasound (US) and Computed Tomography (CT) can detect collections and free fluid due to a BL, imaging confirmation of a biliary origin requires the use of a Hepatobiliary Iminodiacetic Acid (HIDA) scan or Magnetic Resonance Cholangiopancreatography (MRCP) with hepatocyte-specific contrast agent. Biliary strictures can present months to years after the original injury; the attendant biliary dilation is well seen on cross-sectional modalities. MRCP plays a crucial role in excluding features suggestive of a malignant etiology and establishing the type and anatomical extent of the injury for therapeutic planning. Radiologists thus play a vital role in detecting and managing biliary complications. This article provides an overview of the applied anatomy, clinical presentation, imaging, and therapeutic considerations of biliary complications after surgical procedures.