An Integrated Procedure for the Rapid Diagnosis of Biliary Obstruction, Portal Hypertension and Liver Disease of Uncertain Etiology

Abstract An integrated procedure consisting of transhepatic cholangiography, liver biopsy and omentoportography, performed under local anesthesia through a 5-cm subxiphoid incision, was used in 100 patients with hepatobiliary disorders that presented major diagnostic or therapeutic problems. Cholangiography was successful in 80 of 91 patients, liver biopsy in all of 54 patients, and omentoportography in 13 of 15 patients. Diagnosis was achieved in all cases. The frequency of two of the three major complications that occurred should be reducible by sulture ligation of puncture sites. There were no deaths attributable to the procedure. Coagulation abnormalities were present in 29 patients. The only recognized contraindication is sensitivity to contrast medium. The integrated procedure is an effective method of resolving puzzling cases of hepatobiliary disease and should save much time and expense. It has also been helpful in the planning and execution of surgery for biliary obstruction and portal hypertension.