Abstract THE ANATOMICAL location of the distal common bile duct is such that even the experienced surgeon contemplates investigation of this area with extreme caution. Even with the duodenum well kocherized, one gains little information by careful inspection of the posterior aspect of the head of the pancreas, in which the distal common duct is embedded in varying degrees. Careful palpation of this area likewise usually yields little in the way of accurate information, unless one is dealing with a relatively large lesion of the ampulla which protrudes into the duodenal lumen or with a well advanced, distinct carcinoma of the head of the pancreas. Duodenotomy also does not help a great deal unless one encounters a lesion of the ampullary area which has produced gross changes. The various sounding and probing instruments designed for exploration of the common bile duct leave considerable to be desired. When one is confronted with References 1. Nienhuis, L.I.: Routine Operative Cholangiography , Ann Surg 154:192, 1961.Crossref 2. Chapman, M.; Curry, R.C.; and LeQuesne, L.P.: Operative Cholangiography: An Assessment of Its Reliability in the Diagnosis of a Normal Stone-Free Common Bile-Duct , Brit J Surg 51:600, 1964.Crossref 3. Hicken, N.F., and McAllister, A.J.: Operative Cholangiography as an Aid in Reducing the Incidence of "Overlooked" Common Bile Duct Stones: A Study of 1,293 Choledocholithotomies , Surgery 55: 1964. 4. Shapiro, J.H., and Spira, J.: Operative Cholangiography , Amer J Roentgen 91:871, 1964. 5. Abbott, A.C.: A New Instrument for Operative Cholangiography , Surg Gynec Obstet 119:854, 1964. 6. Pyrtek, L.J., and Trowbridge, P.E.: Adaptation of the Venocath for Operating Room Cholangiography , Amer J Surg 109:824, 1965.Crossref 7. Wise, R.E.: Current Concepts of Cholangiography , Surg Clin N Amer 44:736, 1964.
Archives of Surgery – American Medical Association
Published: May 1, 1966