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HYPOTONIC DUODENOGRAPHY IN THE EVALUATION OF CHOLEDOCHOLITHIASIS AND OBSTRUCTIVE JAUNDICE

ROBERT L. BREE M.D.1 and ROBERT F. FLYNN M.D.

1 Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan.

Hypotonic duodenography has been found to be of definite value in the preoperative diagnosis of choledocholithiasis.

By evaluating the size of the papilla of Vater, as visualized on the duodenogram, edema of the papilla can be detected. A papilla larger than 1.5 cm. is considered abnormal.

Nine cases are reported, including 1 false negative because of high impaction of a stone; 1 false positive was carcinoma of the pancreas. One case of carcinoma of the papilla of Vater, showing smooth enlargement of the papilla which we associate with edema, is also presented.

The value of the duodenogram in differentiating obstructive from nonobstructive jaundice is stressed.


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