Excretion cholecystocholangiography; a study based on 1,400 cases examined with telepaque and/or cholegrafin.

Abstract

The frequent demonstration of the biliary ducts following the advent of Telepaque (1) and the magnificent visualization obtained with Cholegrafin (2) gave rise to a large series of scientific communications (3) indicating the importance of these examinations and leading consequently to their routine employment by radiologists everywhere. The present work proposes to set forth the results obtained in a group of 1,400 private patients from the civil population, in whom oral procedure was combined with the intravenous method to determine the normals which in our opinion should be sought routinely in such studies; to learn to recognize the shadows which in certain cases of congenital anomalies serve the surgeon as a guide to successful operative intervention; and to discuss the value of the normal radiologic examination of the biliary passages from the clinical point of view. Although many writers speak of oral or intravenous cholangiography (1–16), the term cholecystocholangiography (17, 18) is more appropriate. To differentiate the procedure from the cholangiography done at operation or with the aid of laparoscopy, it has seemed to us that we should call it “excretion cholecystocholangiography.” This single term includes examination both of the gallbladder and the ducts. In our opinion, in spite of the fact that the substances employed and the methods of introduction into the organs are different, we are dealing with a single radiologic study, which can be accomplished by either means alone or with both at the same time. We begin our examination with the oral method, using Telepaque, (a) because ingestion of the contrast material the preceding afternoon is more easily accomplished than intravenous injection in the office; (b) because failure of visualization of the gallbladder when this organ is permeable shows that its functions of concentration have been lost; (c) because the degree of density is an index of the manner in which these functions have been carried out (20). When the oral procedure fails to produce a gallbladder shadow during elimination of the medium, recourse is had immediately to Cholegrafin, since a large number of gallbladders not shown by Telepaque fill very well with the intravenous preparation (12), and because visibility of the ducts is good in the presence of a vesicular block or when the patient has been cholecystectomized. In such cases we advise that the examination be completed in this one session. In cholecystectomized patients we have often used Telepaque, because, with the technic advised by Twiss and his collaborators (22), and very often with routine examinations, shadows of the common duct and the hepatic trunk duct may be obtained.