抄録
In order to elucidate the clinical implication of no visualization of the gallbladder, the study was performed to 316 patients who were investigated by ERCP because of suspected biliary diseases. Among these patients, there were 72 patients whose gallbladder was not visuallized entirely orr partially, despite sufficient opacif ication of the bile duct, and such cases were one of main f aotors reducing diagnostic accuracy of ERCP. All of these 72 patients were included in 262 pstients who were diagnosed as having biliary disease from the findings of autopsy, operation, clinical investigations and/or clincal course. In all of 54 patients who were diagnosed as non-biliary diseases, the gallbladder was visualized. Fifty nine of non-visualized cases underwent operation. On the basis of surgical and retrograde cholangiographic findings, 59 patients were referred to two different groups; group A 24 patients with stone(s) or stenosis in the choledocus, group B : 35 patients with minimal or no abnormality in the choledocus. The pathological findings of the gallbladder confirmed surgically were (1) stone(s), (2) cholecystitis without stone in the gallbladder, (3) cancer, (4) congenital absence and (5) minimal abnormality. In group A thrse findings were found in 14, 5, 2, 0 and 3 patients, and in group B 27 5, 2, 1 and 0 patients respectively. Among biliary lesions found in these 59 patients, 56 including two resectable gallbladder cancer had indication to surgical treatment, two with hepatic invasion of gallbladder cancer had no indication of radical operetion and in one case with congenital absence of the gallbladder surgery was not indicated. Therefore, when a case of no visualization of the gallbladder is experienced, it is desirable to exclude surgically untreatable biliary lesion from the findings of retrograde choledochogram or other examinations. On the occasion that such lesion is ruled out or is failed to be clarified, surgical treatment or laparctomy may be needed.
