AN ACCURATE diagnosis may be difficult to establish in patients who have jaundice. Clinical features and laboratory findings may frequently be inconclusive. Radiologic study of the biliary tract is un-satisfactory when the serum bilirubin level is elevated.
Because of the uncertainty of diagnosis, some patients with obstructive jaundice are subjected to prolonged periods of observation with the erroneous diagnosis of hepatitis, or patients with hepatocellular damage may undergo an undesirable exploratory laparotomy. Zollinger reported a 16% error in the diagnosis of posthepatic jaundice, also that 6.4% of his patients with intrahepatic jaundice were subjected to laparotomy.28
In 1921, Burkhardt and Müller proposed the percutaneous route to cholecystography by injection of radiopaque material directly into the gallbladder.4 The subsequent introduction of oral cholecystography resulted in lack of interest in this particular approach.11 More recently, Lee, Keil and others have used peritoneoscopic cholangiography, but this approach has not been