Rapid and Accurate Preoperative Diagnosis of Obstructive Jaundice

The usual laboratory and roentgenographic procedures for evaluating patients with obstructive jaundice frequently do not identify the cause as benign or malignant or its exact location. Current practice is to determine this at laparotomy. In an attempt to improve this situation, both percutaneous transhepatic cholangiography (PTC) and selective visceral angiography (SVA) were performed prior to surgery in 25 patients. Results showed that individually SVA was diagnostic preoperatively in 60% of the patients and PTC in 76% of the patients; however, the combination of the two was diagnostic in 96% of the patients. Combination studies accurately predicted the cause in all 19 patients found to have a malignant tumor at laparotomy, although individual studies separately were positive in 72% using SVA and 83% using PTC.