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KMID : 0378019620050030103
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New Medical Journal
1962 Volume.5 No. 3 p.103 ~ p.111
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The Study on Cholecystography
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Abstract
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An experimental study corelating liver function with intravenous cholecystography, bile culture and liver pathology of mongrel dogs in the normal state, after common bile duct ligation, and finally following common bile duct reconstruction is presented. The experiment was performed in the following manner. Thirty apparently healthy dogs, weighing 8-10 kg, were examined preoperatively with concomitant bromsulphalein (BSP) excretion test and intravenous cholecystography with "Biligrafin" as the contrast medium. Following these test and operation was performed in which a culture of bile and a liver biopsy were taken and the commen bile duct ligated just proximal to its entrance into the duodenum. Prior to a second operation 10 days later the BSP and intravenous cholangiography were repeated. At the second operation reconstruction of the common bile duct was performed. Two months later the surviving animals were retested by BSP excretion and cholecystography. Following this the animals were sacrificed and bile culture and liver biopsy were once more performed.
The results were as follows:
(1) In the normal preoperative dogs the gallbladder was visualized after 60 minutes in all dogs. BSP retention averaged 2.5% after 30 minutes. The histopathology of the liver appeared normal in every case and the bile was sterile.
(2) Ten days after common duct ligation, the gall bladder was not visualized until an average of 180 minutes after injection of the dye. BSP retention averaged 9.2% after 30 minutes which is a significant elevation.
(3) Fifteen animals survived for two months after common duct reconstuction. Seven had visualization of the gall bladder in 60 minutes and average BSP retention after 30 minutes was 1.4%. Histopathology was normal and bile cultures were negative. Three animals had visualization in 120 minutes. Two of these had infected bile and showed slight liver damage on pathological examination, but the BSP was normal (2%) retention.
(4) In five animals there was no visualization of the biliary tree. BSP retention averaged 6.4%, the bile was infected in all cases and pathological examination showed moderate damage to the liver.
It is the authors opinion that the normal range of BSP is 2.5% retention in 30 minutes and that in cases where this is true the cholecystogram should show visualization of the biliary tract in 60 minutes. Failure of radiographic visualization with 60 minutes represents either disease of the liver or the bile ducts and/or the gall bladder. If concomitant performance of cholecystography and BSP reveal a normal BSP then the failure of visualization indicates disease of the bile ducts or gall bladder. He recommends the simultaneous performance of BSP clearance test and intravenous cholecystography.
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