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June 1970

Source of Error in Operative Cholangiography

Author Affiliations

Winchester, Va
From the Winchester Surgical Clinic and departments of surgery (Dr. Custer) and radiology (Dr. Clore), Winchester Memorial Hospital, Winchester, Va.

Arch Surg. 1970;100(6):664-667. doi:10.1001/archsurg.1970.01340240032006

Although operative cholangiography is without question a helpful and a generally reliable means of evaluating the biliary duct system, certain potential exists for technical or interpretive error. The source of such error includes (1) air bubbles; (2) improper position of patient in relation to x-ray source; (3) "coning" of the distal common duct; (4) confusion of functional for organic obstruction; and (5) inclination on the part of the surgeon to disregard evidence before him. Substantial improvement results from (1) prefilling the injection system to avoid air bubbles; (2) rotation of the operating table 15 degrees to the right to place biliary tract in relief of vertebral column; (3) proper interpretation of "coning" effect; (4) acceptance of spasm as an obstructive factor following choledochotomy; and (5) persistence in a given study until complete delineation is obtained.