SELECTIVE CHOLANGIOGRAPHY FOR THE DETECTION OF INTRAHEPATIC STONES AND ITS SIGNIFICANCE

• Published in: Journal of The Showa Medical Association Vol. 47; no. 4; pp. 569 - 575
• Main Authors: IKEDA, Tadaaki, NAKAYAMA, Toshiro
• Format: Journal Article
• Language: English; Japanese
• Published: The Showa University Society 1987; 昭和大学学士会
• ISSN: 0037-4342; 2185-0976
• DOI: 10.14930/jsma1939.47.569

Intrahepatic cholelithiasis is a disease being difficult to be identified and treated. We encountered 18 cases having Intrahepatic stones among 584 cases with cholelithiasis during the recent decade (August, 1975 to June, 1985) . Excepting 7 cases undergoing hepatectomy, the remaining 11 cases received lithotomy in aid with cholangioscopy; namely, operative cholangioscopy (OC) was employed in 1; postoperative cholangioscopy (POC) in 7; and percutaneous transhepatic cholangioscopy (PTCS) in 3. Since we should be careful with residual stones, regardless of treatment methods, we tried directly to observe bile ducts using a baby scope through a cholangioscope in the cases showing poor cholangiograms due to the presence of pneumobilia or obstruction of peripheral bile ducts; however, clear observation was impeded by the structure of the liver. Selective cholangiography was then applied to 7 cases examined with POC, and this method provided satisfactory results. In these cholangiograms, peripheral bile was replaced by contrast medium through the use of a balloon catheter, and clear features of stones without air bubbles were seen, resulting that residual stones, which cholangiograms using a conventional catheter failed to show, could be detected in 3 cases. Since gram-negative organisms were isolated as highly as 91.5% (54 strains: n=60) by cultures of the bile collected from a fistula of a T tube, the occurrences of retrograde infection with these bacteria to the blood and cholangiovenous reflux were apprehended during the use of a balloon cathter, where bile ducts exposed to slightly high pressure. However, when changes in body temperature, WBC, S-GOT, S-GPT, LDH and AL-P before and after examination were compared between cases (n=15) examined by the method using a balloon catheter and control subjects undergoing ERC (n=20), there were no significant differences. These results indicated that selective cholangiography performed using a balloon catheter under cholangioscopic observation was a safe and useful device for the confirmation of the presence or absence of residual stones which were stuck in peripheral bile ducts and could not be directly seen during cholangioscopic lithotomy of intrahepatic stones.