Cholangiography

Cholangiography is the method of roentgenologic examination of the bile ducts by direct injection of contrast material into the bile ducts (before the operation - by percutaneous or perhepatic puncture, on the operating table through a catheter inserted into the common bile duct, after the operation left in via biliary tract drainage tube), followed by x-rays. On cholangiogram reveal stones in the bile ducts, the strangulation of their tumor and other changes. The cholangiography exercise jointly surgeon and radiologist. Cm. also Holografia.

Cholangiography (from the Greek. chole - gall, angeion - vessel and grapho - writing, picture) - x-ray method of examination of the bile ducts by direct injection of contrast medium into the bile paths followed by radiography or by rentgenonegativee. Depending on the way and how the introduction of a contrast agent, there are several basic options cholangiography.
Perhepatic cholangiography. A contrast agent is injected directly into one of the major intrahepatic bile duct through a puncture in the abdominal wall. This is a technique used mainly in patients with jaundice to ascertain its causes and determination of the place and nature of obstruction of the bile ducts (blockage of stone or tumor, cicatricial stricture, stenosis of Vater's papilla and other).
Perhepatic cholangiography may be complicated by bleeding from a needle, hemobilia, the secretion of bile into the abdominal cavity. Such intervention is usually made before the operation.
Percutaneous cholangiography (laparoscopy). The introduction of a contrast medium into the bile ducts are carried out through the gallbladder. Bubble dotted line through the abdominal wall after imposition of pneumoperitoneum under the control of the laparoscope. In view of the risk of expiry of bile through the puncture hole research is recommended before surgery. It is used mainly for the differential diagnosis of jaundice and pre-operative diagnosis of primary stenoziruyuschego papillae.
Cholangiography on the operating table produces the surgeon after opening the abdominal cavity and inspection of the liver and intrahepatic bile ducts to surgical manipulations on these bodies. The best way when operating cholangiography consider the introduction of a contrast agent through the catheter is carried out through the cystic duct into the common bile duct. In addition, the contrast agent may be set up in the gallbladder, the stump of the cystic duct, right in the bile duct, through the opening of Vater nipple when opened the duodenum. X-rays are performed on the operating table using a mobile device and interpreted together as a surgeon and radiologist. Often the cholangiography accompany pressure measurement in the biliary tract, allowing for more accurate to judge about the function of the sphincter of Oddi. At the end of operation the cholangiography usually repeat to determine whether there was in the ducts of stones and what cross duct or created anastomoses.
Post-operative cholangiography is performed by the administration of contrast agent through a drainage tube or catheter is left in the biliary tract.
The main task of the research was to establish the patency of the bile ducts and the function of the sphincter of Oddi.
The cholangiography through fistula (fistulography) produce to assess
patency artificially created anastomoses between the biliary tract and the digestive tract or for research spontaneous external and
internal biliary fistula. Contrast dye is injected through the outer fistulous hole or through fistula with gastrointestinal tract (after taking ill-suspension of barium sulfate).
All kinds cholangiography give an idea of morphological and functional state of the bile ducts. On cholangiogram can be judged on the cross ducts, their location, size, shape, pathological changes (Fig. 1 - 3). The introduction of a contrast medium into the biliary tract is recommended under the control of scanning (the most promising for this electronic-optical x-ray image amplifiers and rentgenoterapii). This allows you to adjust the amount of preparation and to choose the optimum time of the shooting.
OK contrast dye moves freely through the bile ducts and passes into the duodenum. On sighting photographs and footage can reflect the different phases of the activity of the sphincter of Oddi. When hypertension is found moderate expansion of the bile ducts and the slow transition of contrast in the colon. A very similar picture sometimes gives stenosing papilla. To distinguish these States have resorted to pharmacological tests, for example injected 0.25 mg atropine sulfate. If the contrast agent is moving rapidly in the gut, then there is a functional nature of the obstacles. If hypotension sphincter intrahepatic ducts also extended, but the contrast agent is flowing in the gut quickly and in large numbers.
Cholangiography allows you to diagnose a variety of options and anomalies of biliary tracts, their kinks and stricture, compression duct tumor. The special value all kinds cholangiography have in the identification of stones in the bile ducts (Fig. 2 and 3).

Fig. 1. Cholangiography on the operating table. The bile ducts are evenly filled by contrast agent, slightly expanded, do not contain stones. The contrast agent freely enters the duodenum.
Fig. 2. Cholangiography on the operating table. The bile ducts strongly enhanced. In the common bile duct, there are two stone governing the filling defects in the shadow of the duct. Part of contrast passed into the duodenum.
Fig. 3. Post-operative cholangiography through the drain tube. The bile ducts expanded. Cicatricial deformity of the common bile duct, in the lumen of which there are stones that contribute to filling defects. Due to spasm of the sphincter of Oddi contrast agent does not enter into the duodenum.