Diagnosis of gangrene and perforation of the gallbladder by endoscopic retrograde cholangiography.

Conventional radiographic procedures are not helpful in the preoperative documentation of gangrenous cholecystitis or gallbladder perforation. Three cases in which preoperative diagnosis was accomplished by endoscopic retrograde cholangiography are described. Gangrene was identified in all three by a shaggy outline of the gallbladder wall with amorphous debris and stones in the lumen. Perforation was identified in two of the cases by extravasation of contrast material into a pericholecystic abscess. This information, as well as the status of the common duct, was important to the surgeon.