Abstract
A review of accumulated experience with 423 attempts at percutaneous transhepatic cholangiography verifies the usefulness of this procedure in differentiating obstructive from non-obstructive jaundice. The procedure is not uniformly successful nor is it infallible. Failure to aspirate bile is not a completely reliable indication that posthepatic obstruction is not present. Conversely, aspiration of bile after introduction of the exploring needle or catheter, without obtaining a cholangiogram, should not be used as proof of extrahepatic obstruction. Although fatalities are rare, complications occur and percutaneous transhepatic cholangiography is not without risk, especially of bile peritonitis. Bile peritonitis may ensue even when the exploring catheter is left in situ. It would seem wiser and safer, therefore, to schedule operation within 4–8 hr. of transhepatic cholangiography when an obstructing lesion has been identified, or when the examination is unsuccessful and diagnosis is still obscure. The procedure would appear to be especially valuable in cases of jaundice in which the diagnosis is still in doubt after all other studies have been performed. However, the hazards attending its performance alone dictate that it not be used inall cases of obstructive jaundice.
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