Intravenous cholecystangiography.

Abstract

The recent discovery of a chemical compound, Cholografin, has made it possible to demonstrate the bile ducts roentgenographically even though the gallbladder is absent or abnormal. The greatest advantage of this new intravenous method is in studying the biliary tree of the patient who has had a cholecystectomy. It has also proved valuable in cases of gallbladder disease in which the ordinary Graham test has been unsuccessful. This paper, based upon the first 100 cases selected for examination with Cholografin in a hospital and private radiological office in one community, indicates the usefulness, advantages, and limitations of the new chemical. Selection of Patients Originally the limited supply of Cholografin2 restricted its use to cholecystectomized patients, to those in whom nausea or vomiting precluded the employment of an oral medium, and to those in whom diagnosis by the routine oral method was equivocal. Later, as the material became more available, its use was extended to certain cases at the special request of the surgeon or internist. Forty of the group examined had undergone cholecystectomy and in 60 the gallbladder was present. Technic A dose of 20 c.c. of the 20 per cent solution injected into the cubital vein was found sufficient for routine cholecystangiography. In obese patients and in cholecystectomized patients, however, twice that amount was employed. The manufacturer's instructions were followed closely in preparing the patient, testing for sensitivity, rate of injection, and timing the radiographic exposures (1, 5, 7). Special views, such as the vertical, lateral recumbent, and oblique were utilized as indicated. The most rewarding results of an examination occurred when each radiograph was viewed as soon as possible after its development, in order that the technic could be adapted to the individual case. The examination was not carried out when jaundice was present but was delayed until the icterus had nearly or completely subsided. European investigators had reported (4, 7, 8, 11) that in the presence of liver damage Cholografin was excreted mainly in the urine. Results of Examinations The findings in the 40 cholecystectomized patients were as follows: The symptoms in this group varied from mild indigestion to agonizing attacks of biliary colic. The interval between the performance of cholecystectomy and examination ranged from less than a year (in 5 patients) to twenty-five years. In 37 cases Cholografin outlined the biliary tree; in 26 of these the ducts were normal and in 11 some abnormality was found. The 4 cases of common duct stones were confirmed surgically (Fig. 6). Quite impressive were the cystic duct remnants, ranging from 3 to 5 cm. in length (Fig. 5); of even more interest was the sac formation at the end of the cystic duct (Fig. 3). A serious error of interpretation nearly occurred in one patient (Fig. 4), in whom reflux of Cholografin into the duodenal bulb simulated a gallbladder remnant.