Abstract
We carried out peritoneoscopic examination in 770 patients and performed direct cholecystography and transhepatic cholangiography in 100 out of these patients who were suspected of diseases of biliary tract. Direct cholecystogaphy was utilized a Kiyonaga's instrument for gallbladder puncture and sucked juice in gallbladder as large quantity as possible, then 30% Biligrafin solution (20% in cases suspected stones) was injected approximately same of absorbed juice. Transhepatic cholangiography was injected 40-60 ml of the same contrast media through a needle (external diameter 0.8 mm) introduced into the intrahepatic bile duct under peritoneoscopic control. Direct cholecystography was successfully perf ormd in 69 of 96 cases. In 30 cases with the contracted or lumped gallbladder, puncturing was so difficult that direct cholecystography was successful in only 14 cases. Transhepatic cholangiography was successful in 20 of 24 cases in which the intrahepatic bile ducts were dilated and in 2 of 6 in which the ducts were not dilated. Recently using of a fine polyethylene catheter (internal diameter 1.5mm) for sucction of intrahepatic bile juice is bringing about a good result. Unsuccessful contrast filling of bile ducts by direct cholecystography was obsered in 6 cases. Five cases were stones of the gallbladder and one case was carcinoma of the common bile duct. In one case with stone of the neck of gallbladder, swelling of the duodenal papilla caused jaundice was observed by transhepatic cholangiography. In these cases the cause of obstructive jaundice was unknown on direct cholecystogram, so adoption of transhepatic cholangiography at the same time was important. Thirty cases with extrahepatic obstructive jaundice were investigated the distal end of common bile duct on cholangiograms. The types of obstructive end were as follows : carcinoma of the pancreas head, mainly U-shaped type; choledocholithiasis, round translucent or contrary U-shaped type and carcinoma of the duodenal papilla, contrary U-shaped type in all cases. Impacted stone at ampulla was differentiated from carcinoma of the duodenal papilla in demonstration of a figure like to eagle nail. For prevention of bile leakage 4 ml of oily tetracyclin was injected into the wall of gallbladder on direct cholecystography and stop a needle below the hepatic capsule a few minutes on transhepatic cholangiography. Bile peritonitis as a result of bile leakage was observed in one case. Serious bleeding into the peritoneal cavity was not observed.
