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June 3, 1974

Percutaneous Transhepatic Cholangiography: A Plea for Selective Use

Author Affiliations

From the New York University School of Medicine, New York.

JAMA. 1974;228(10):1259. doi:10.1001/jama.1974.03230350031022

ON Dec 18, 1950, I saw a 76-year-old white woman at Manhattan State Hospital, New York City, who was jaundiced and semicomatose, with an enlargement of the liver three finger-breadths below the right subcostal margin, and in whom liver function studies showed extrahepatic obstructive jaundice. Permission for surgery was refused by the family, but consent was given for the insertion of a needle into the liver, in an effort to obtain a cholangiogram.

With the patient lying flat in bed, suction was applied with a syringe that was attached to an 18-gauge short-beveled spinal needle. The needle was then inserted into the right subcostal area and directed towards an enlarged major bile duct. On obtaining white bile, 40 ml of 35% iodopyracet (Diodrast) was injected, and with a portable x-ray machine, a cholangiogram was made. Polyethylene tubing was inserted through the lumen of the needle, the lumen was withdrawn, and