Hepatobiliary scintigraphy of evolving spontaneous biliary leak

The patient is a 44-year-old woman with Crohn's disease, who presented to the ED with abdominal pain. Initial imaging by CT and US showed mild biliary tree dilatation, mild gallbladder distension, and pericholecystic fluid. The cystic and common bile ducts were patent without bile leak on cholescintigraphy. The next day, MRCP revealed free fluid extending from the gallbladder fossa to the right lower quadrant. Subsequently, a repeat cholescintigraphy was performed which was positive for bile leak. This case highlights the use of multiple imaging modalities in assessing abdominal pain, pre-and post-biliary leak.