PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY

Chemical and histological studies are often unable to differen tiate chronic extrahepatic obstructive jaundice (due to calculi, neoplasia, or stricture) from chronic intrahepatic obstructive jaundice (caused by primary biliary cirrhosis or by drugs, . notably anabolic steroids and phenothiazine derivatives). Oral and intravenous cholangiography are also ineffective when the serum bilirubin is greater than 2-3 mg./100 ml. In such circumstances percutaneous transhepatic cholangiography may be useful, since this method can demonstrate the dilated intra hepatic biliary system which develops in chronic extrahepatic obstruction ; while a negative result may remove the need for laparotomy in a patient with hepatocellular disease. Since Atkinson et al. (1960) remarked on the revival of interest in this investigation numerous authors (Santos et al., 1960 ; Kaplan, et al., 1961 ; Shaldon et al., 1962 ; Arner et al., 1962 ; Flemma et al., 1963) have agreed on its value. Only one of these reports has come from this country, and the British Medical Journal (1964) suggests that percutaneous transhepatic cholangiography has still to gain general acceptance in Great Britain. This report of a small series with a case history and a brief survey of recent studies may be of interest.