Intravenous Choledochography with a New Contrast Medium, “Cholografin”

Abstract

It is now possible to visualize the hepatic and common ducts in cholecystectomized patients by the intravenous use of a new preparation called “Cholografin”2 (1) . This compound is the disodium salt of N:N1 adipic-di (3-amino-2:4 :6-triiodophenylcarboxylic acid). It is prepared as a 20 per cent isotonic solution. The iodine content, 64.32 per cent, is firmly bound in the molecule and not split off after the substance is injected intravenously. The substance is actively excreted by the liver cells and appears in the bowel a few minutes after intravenous injection. The common duct fills within twenty minutes and can be demonstrated roentgenographically. In the presence of jaundice, however, the common duct is not visualized. Instead, the compound is excreted by the kidneys in sufficient concentration to produce good urograms. Following cholecystectomy, symptoms may recur which resemble or are identical with those which existed prior to operation. These symptoms may appear shortly after surgery or may develop several months or years later. The most common causes for persistence of symptoms following cholecystectomy are erroneous preoperative diagnosis, calculi in the biliary ducts, common duct stricture, stone or inflammation of the cystic duct remnant, adhesions involving the stomach or the duodenum, residual cholangitis, hepatitis and pancreatitis, removal of functioning gallbladder, biliary dyssynergia, and an unrecognized malignant lesion U). The diagnosis of common duct stone in the post-cholecystectomy patient is not difficult when there are typical attacks of biliary colic followed by jaundice, and sometimes chills and fever . The problem is less easily solved in many patients who have attacks simulating biliary colic in the absence of jaundice. Technic of Examination The examination is best carried out in the morning, and the patient must be fasting. A laxative, such as castor oil or compound licorice powder, may be given the night before the examination. During a period of six to ten minutes, 40 c.c, of a 20 per cent solution of the medium is injected intravenously. If the injection is given too rapidly, some reaction may occur. Films made at twenty minutes after injection are viewed while wet, in order that exposure intervals and positioning of the patient may be changed if necessary. Correct positioning is important. multiple film studies with different degrees of rotation in both the erect and recumbent positions and in the lateral decubitus are helpful in separating overlying ribs and gas shadows from portions of the main hepatic and common ducts. For good contrast, 45 to 50 kv. and 400–800 mas. are used. Reactions If the tissues around the veins are injected inadvertently, local irritation will result. Slight nausea, dizziness, sneezing or restlessness occurred after injection in a few of our cases, but this was believed to have been due to rapid injection.