Cholangiography direct

The use of direct cholangiography is indicated (7.) if alterations in the area of the efferent bile ducts could not be clarified by ultrasound and i.v. cholangiography or (2.) if the use of i.v. cholangiography is contraindicated, not indicated or likely to be inadequate. Various direct cholangiographic methods are available depending on individual pathological situations and diagnostic issues, (s. tab. 8.8)... 

Merrill, J.R. Operative cholangiography by direct puncture of the common bile duct. Surg. Gynec. Obstetr. 1984 158 331-334... 

Direct cholangiography is anyway the best method for detailed anatomy of the biliary tract, often showing aberrant entry of the common bile duct into the side of the pancreatic duct. 

Direct cholangiography is indicated in patients with peripheral CCA only in rare situations, i.e. to detect contralateral bile duct involvement. The mass and its satellites give the intrahepatic ducts an encased or scalloped appearance. The smooth, variable length stricture affects adjacent ducts within the same hepatic territory. This appearance is usually not mistaken for the peripherally invading Klatskin s tumour, but care is required not to interpret these findings as primary sclerosing cholangitis (PSC). 

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