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PubMed1988

ERC cholecystography.

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Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1995

[Left single-lobe Caroli disease discovered during intraoperative cholecystography ... or how a routine cholecystectomy can lead to left hepatectomy].

The authors report a case of single-lobe Caroli's disease discovered at the radiologic exploration during a laparoscopic cholecystectomy leading to a left hepatic lobectomy 2.5 months later. Localized dilatation of the intrahepatic bile-ducts are infrequent. They may be associated with others pathological conditions such as cystic dilatation of the extrahepatic bile-ducts, congenital hepatic fibrosis of the liver or renal pathology. Hepatic resection is the logical treatment of such localized lesions, but it may have an excessive risk in case of association with a congenital hepatic fibrosis of the liver. The authors insist about the necessity of radiographic exploration during every biliary surgical approach, even with laparoscopic technic.

Caroli Disease↗
PubMedDate not supplied

The present status of imaging of the gallbladder.

Oral cholecystography is still the basic modality for the diagnosis of gallbladder disease. Now, for the first time since the introduction of this procedure in 1924, this status is being challenged by another diagnostic technique, ultrasonography of the gall bladder. Ultrasound studies have major advantages over conventional cholecystography. These are sufficiently important that it can be safely predicted that ultrasonography will eventually become the primary diagnostic tool for evaluating the gallbladder. Just as the use of colonoscopy has provoked a new analysis of the barium enema examination in the evaluation of the colon, the introduction of ultrasound examination of the gallbladder has revealed the fact that false-negative oral cholecystograms are not rare. Before ultrasonography this information was unobtainable, because of the surgeon's proper reluctance to perform a cholecystectomy in patients with normal oral cholecystograms. Indeed, the availability of an accurate alternate diagnostic procedure has stimulated a reevaluation of other difficulties associated with oral cholecystography. These include problems involved with non-visualization and impaired visualization of the gallbladder after a single dose of contrast material, misunderstandings concerning the uses of oral cholecystography compared to those for intravenous cholangiography and uncertainty regarding the value of cholecystokinin cholecystography in the diagnosis of acalculous cholecystitis. Knowledge of the pharmacokinetics of the oral cholecystographic contrast agents has been long overdue, considering the extensive use of these compounds in clinical practice for more than 50 years. However, information on this subject has finally reached a stage where the data can be applied to ensure that cholecystography is done with maximun efficiency and safety and with the least radiation exposure. The purpose of this report is to review the problems involved with imaging of the gallbladder by oral cholecystography and to discuss the indications, interpretation and accuracy of gallbladder imaging with ultrasonography. Data concerning the use of computerized tomography for evaluation of the gallbladder are still preliminary but are discussed.

Administration, Oral↗
PubMed1991

[Imaging procedures prior to the extracorporeal shockwave lithotripsy of gallstones].

In order to determine whether cholecystography and computed tomography (CT) are capable of better gallstone characterization than conventional radiography alone, 91 patients (76 females, 15 males; mean age 47 +/- 12 years) with symptomatic single gallstones were studied prospectively prior to extracorporeal shock-wave lithotripsy with concomitant oral stone dissolution therapy. In addition, the value of oral cholecystography in demonstrating patency of the cystic duct was compared with ultrasound assessment of gallbladder function. Despite "negative" plain gallbladder radiographs in all patients, oral cholecystography showed significant stone calcification in 8 of the 91 patients and CT showed stone calcifications in 52 of the 91 patients. In 12 patients the maximum stone density was between 50 and 90 Hounsfield units, and in 40 patients it was more than 90 Hounsfield units. CT revealed ring-like calcification in the majority (79%) of these stones. Oral cholecystography showed satisfactory concentration of contrast medium in all patients, while ultrasonography of the gallbladder following a chemically defined test meal demonstrated contractility of more than 50% of initial volume in 69 patients and of less than 30% in 9 patients. Although oral cholecystography is a simple, readily available complication-free method, ultrasound assessment of gallbladder contraction is better for selecting patients for extracorporeal shock-wave lithotripsy. CT allows significantly better characterization of gallstones than oral cholecystography and conventional plain gallbladder radiography.

Adult↗
PubMed1985

Detection of gall stones after acute pancreatitis.

Four methods of gall stone diagnosis after an attack of acute pancreatitis are analysed. Of 128 consecutive patients with acute pancreatitis, 99 patients were discharged from hospital without a definite aetiology. These patients had biochemical tests performed on admission and ultrasonography and oral cholecystography performed six weeks later. The sensitivity for ultrasonography was 87% and the specificity was 93%; the respective figures for oral cholecystography were 83% and 90%. The predictive value of positive ultrasonography was 100% and of negative ultrasonography 75%; the respective values for oral cholecystography were 95% and 68%. A combination of ultrasonography and oral cholecystography failed to detect nine of 70 patients with gall stones (13%). Of 35 patients with normal ultrasonography and oral cholecystography, 33 patients had an endoscopic retrograde cholangiogram (ERCP) which showed gall stones in a further seven patients. All three methods failed to reveal gall stones in two patients, confirmed by laparotomy. The sensitivity of admission biochemical analysis was 73% and the specificity was 94%; the predictive value of a positive result was 97% and of a negative result was 57%. Biochemical analysis predicted gall stones in six of the seven patients shown by ERCP. Only 9% of patients were finally considered to be idiopathic. In conclusion ultrasonography is the investigation of choice and ERCP should be undertaken in all patients who have normal ultrasonography and/or oral cholecystography but have biochemical criteria indicative of gall stones.

Acute Disease↗
PubMed1982

Gall-stone dissolution and recurrence: are we being misled?

Oral cholecystography repeated at six-months intervals is the standard method for determining reduction in size of gall stones (partial success) and complete dissolution of stones (complete success). In a comparative study of oral cholecystography and cholecystosonography six out of 14 patients with gall stones achieving complete success by oral cholecystographic criteria had stones still detectable by ultrasonography. Repeat oral cholecystography in a further 11 patients receiving post-dissolution maintenance treatment detected stones in two, whereas ultrasonography detected stones in seven. In future complete dissolution of gall stones should be reported only if both oral cholecystography and ultrasonographic studies give negative results and the progress of patients receiving post-dissolution maintenance treatment is monitored by ultrasonography rather than serial oral cholecystography.

Chenodeoxycholic Acid↗
PubMed1989

Screening for cholelithiasis prior to aortic reconstruction.

A study was undertaken to determine the value of preoperative oral cholecystography and the incidence and complications of cholelithiasis in patients undergoing aortic reconstruction. Over an 11-year period, 785 patients underwent aortic reconstruction. Forty-seven had a previous cholecystectomy; of the 738 remaining patients, 394 underwent preoperative operative oral cholecystography to screen for cholelithiasis. Seventy-three (18 percent) were found to have gallbladder disease. Thirteen had symptoms attributed to cholelithiasis and underwent cholecystectomy with aortic reconstruction. Three hundred eighty-one were left with the gallbladder after aortic reconstruction, 60 in whom disease was identified and 321 with normal oral cholecystography results. Three patients developed cholecystitis in the postoperative period, one in the diseased group and two with normal gallbladders. The incidence of postoperative cholecystitis was 0.8 percent (3 patients). Preoperative oral cholecystography is of little value as a screening tool. Cholecystectomy during aortic reconstruction is probably safe and the risk of postoperative cholecystitis in the asymptomatic patient is negligible.

Aorta↗
PubMed1984

Ultrasonography versus roentgenography in suspected instances of cholecystolithiasis.

In a consecutive series of 102 patients with no jaundice and with symptoms of cholecystolithiasis, the predictions from both ultrasonography and cholecystography were compared with the final diagnosis. The accuracy of both examinations was high. However, in 38 per cent, single dose oral cholecystography failed to visualize the gallbladder whereas ultrasonography was conclusive in all patients. Judged by a simple scoring system, ultrasonography obtained a significantly better score than cholecystography (p less than 0.01) and an insignificantly better score than combined oral and intravenous cholecystography (0.05 less than p less than 0.1). Ultrasonography is recommended as the primary investigation in suspected instances of cholecystolithiasis.

Adult↗