Is intravenous cholangiography still useful?

A retrospective study was performed to determine the usefulness of the intravenous cholangiogram for evaluation of common bile duct disease. Using interpretations obtained by chart review, 128 intravenous cholangiograms were categorized according to common bile duct visualization. Fifty-five percent of the studies were considered technically adequate for interpretation, while 23% and 22% were suboptimal and nondiagnostic, respectively. The intravenous cholangiogram diagnoses were verified when possible by comparison with the findings of: (a) endoscopic retrograde cholangiography, (b) operative cholangiography, (c) choledochotomy, or (d) autopsy. In verified studies of adequate intravenous cholangiograms, the diagnostic error rate was 40%, largely owing to missed stones. We conclude that the intravenous cholangiogram is usually unreliable for biliary tract evaluation, and should be replaced by alternative studies such as endoscopic or transhepatic cholangiography.

The normal cholangiogram.

This paper describes the measurements of the normal cholangiogram as demonstrated by endoscopic retrograde cholangiopancreatography. Two groups of patients were studied. There were 49 patients who had normal livers and no evidence of biliary tract disease. In addition, there were 25 patients with known liver disease and an apparent normal extra-hepatic biliary tract. The extrahepatic bile duct was measured in three regions: (1) the common hepatic duct (above the cystic duct and below the bifurcation); (2) the prepancreatic portion (below the cystic duct and above the pancreas); and (3) the interpancreatic portion (bile duct within the pancreas). These measurements ranged from 2.1 to 9.2 mm. Although the common bile ducts were generally quite uniform in caliber, there were instances where each portion was the largest diameter in an individual case. There was slight increase in bile-duct caliber with age. This study showed somewhat smaller measurements than previously reported and may relate to case selection in this or previous studies.

The role of intestinal gas in functional abdominal pain.

A washout technic with intestinal infusion of an inert gas mixture was used to study the relation of gas to functional abdominal symptoms. The volume of gas in the intestinal tract (176 plus or minus 28 ml S.E.M.) of 12 fasting patients with chronic complaints of excess gas did not differ significantly (P greater than 0.10) from that of 10 controls (199 plus or minus 31 ml). Similarly, there was no difference in the composition or accumulation rate of intestinal gas. However, more gas tended to reflux back into the stomach in patients who complained of abdominal pain during infusion of volumes of gas well tolerated by controls. Six patients with severe pain during the study had intestinal transit times of gas (40 plus or minus 6 minutes S.E.M.) that were significantly (P less than 0.05) longer than those of the control group (22 plus or minus 3 minutes). Thus, complaints of bloating, pain and gas may result from disordered intestinal motility in combination with an abnormal pain response to gut distention rather than from increased volumes of gas.