Comparative evaluation of preoperative and operative radiology in biliary-tract disease

Abstract In 100 consecutive patients with an abnormal cholecystogram a study was carried out to compare the value of the 4-day Telepaque test, intravenous cholangiography, and operative cholangiography. Of the 100 patients, 87 were shown at operation to have stones in the gall-bladder and 22 to have stones in the common bile-duct. In 4 of the latter patients, stones were absent from the gall-bladder. Operative cholangiography was the most accurate investigation in the diagnosis of a stone in the common duct; the operative cholangiogram gave definite evidence of stones in the duct in 20 of the patients, and was abnormal in some respect in all of the patients with a stone in the common duct. It is concluded that this investigation should be performed on all patients undergoing cholecystectomy. The 4-day Telepaque test demonstrated stones in the gall-bladder in 30 per cent of the patients with a non-functioning gall-bladder on oral cholecystography, thus materially improving the diagnosis of gall-bladder stones preoperatively. Of duct stones, however, only 32 per cent were shown by the 4-day Telepaque test, and 59 per cent were demonstrated by intravenous cholangiography. In view of the risk associated with Biligrafin, and to a lesser extent with large doses of Telepaque, it is concluded that neither of these tests is desirable prior to cholecystectomy in the good-risk patient, provided that a satisfactory technique of operative cholangiography is used. They should be reserved for the poor-risk patient, when the presence or absence of duct stones may influence the decision to operate.