7 - Disorders of the Extrahepatic Bile Ducts

Abstract

SUMMARY Biliary problems are solved only by thorough investigation. In the jaundicefree patient biliary radiology is indicated in addition to routine biochemical tests. If the patient presents with probable obstructive jaundice, liver biopsy, barium meal, duodenography and possibly also a percutaneous cholangiogram may be indicated, to reveal the site and type of obstruction. Unnecessary operations will be avoided by this means. Once operation has been decided upon, routine operative cholangiography demonstrates normal anatomy or reveals any abnormalities of structure or function, thus avoiding damage to the bile ducts which might result in stricture formation. There is always a cause for obstructive jaundice and no abdomen should be closed until the cause can be elucidated by biopsy of liver or any other pathological tissue, and operative cholangiograms have been taken to show the complete biliary tree and adjacent duodenum. After stones have been removed, and a stricture or neoplasm has been adequately treated surgically, post-exploratory X-rays are advised to demonstrate that no abnormality remains. By this means we avoid leaving a calculus in the ducts, or an undiagnosed hepatic duct carcinoma or periampullary lesion and, most important of all, there is little chance of the later development of a biliary stricture with its frequently tragic sequelae.