[Computed tomographic cholangiography in the diagnosis of choledocholithiasis in severe bilirubinemia]

Cholangiography used with oral or intravenous contrast agents has gained wide acceptance as the most objective preoperative diagnostic technique for choledocholithiasis. However, an indirect contrasting technique has been found quite unfit in patients with severe bilirubinemia. Despite this, the authors employed indirect contrasting of the bile ducts in 104 patients with severe bilirubinemia in combination with computed tomographic cholangiography. Contrasting took place in 90 (86.5%) patients. In complete obstruction of the choledochus (10 patients), intraductal hypertension prevents the contrast agent and bile from entering the hepatic ducts and the contrast agent is excreted by the kidneys. Thus, the use of the latest equipment and computers allows one to detect minor biliary contrast concentrations during indirect contrasting of the biliary tract in severe bilirubinemia.