Drip-Infusion Cholecystocholangiography

Oral cholecystography is the method of choice for the visualization and radiological study of the function of the gallbladder. In 10 per cent of cases, however, the gallbladder is not visualized although the cystic duct is patent. This may be due to inadequate absorption of contrast medium from the intestine. Alternatively, if the contrast medium is absorbed, it may not be concentrated sufficiently in the gallbladder to cast a radiographic shadow, possibly because of reabsorption of the medium from an inflamed gallbladder mucosa (2, 18, 22). When there is failure to outline the gallbladder at oral cholecystography, intravenous cholangiography is indicated. With the conventional injection technic, contrast is quite often poor or insufficient for accurate diagnosis, and the examination is usually unsuccessful in the presence of a serum bilirubin of 3.0 mg∕100 ml or higher. A method of cholangiography is here described whereby iodipamide is administered by controlled slow intravenous infusion. It is felt that the method has significant advantages over the conventional technic. Method and Material A series of unselected patients referred for cholangiography were examined by both the conventional and the infusion technics (within forty-eight hours), and the results were compared. The degree of opacification of the biliary tract by each method was graded as excellent, good, poor, or nil. The first two categories were regarded as adequate and the second two as inadequate for diagnostic purposes. A qualitative assessment of this nature has the advantage of simplicity and reflects the appearance of the radiographic image as a whole. In all the cases with abnormal findings at cholangiography, the diagnosis was verified at operation. Technic Fasting for eight hours prior to the examination was the only preliminary preparation employed. Injection Technic: After preliminary radiography of the right upper quadrant of the abdomen, 40 ml of 50 per cent iodipamide2 was slowly injected intravenously over a ten-minute period. Appropriate radiographs of the biliary tract, including tomographic cuts if necessary, were taken at twenty, forty, sixty, and ninety minutes and four hours after injection. If the gallbladder was visualized, a further film was obtained thirty minutes after a fatty meal. A twenty-four-hour film was taken if the biliary tract was not opacified on any of these films. Infusion Technic. The dose of iodipamide was determined on the basis of 42 ml per 70 kg body weight. The rationale for this is discussed below. The contrast medium was diluted in 250 ml 5 per cent glucose and administered by slow intravenous infusion over a period of two hours. At the end of the infusion appropriate films of the gallbladder and bile ducts were obtained, and tomography was employed if necessary. If the gallbladder was visualized, a further film was taken thirty minutes after a fatty meal.