Ultrasonic scanning in postcholecystectomy choledocholithiasis.

Ultrasonic scanning of the right upper quadrant was performed in four patients with jaundice and fever. Each patient had undergone a previous cholecystectomy with common bile duct exploration for biliary tract calculi. No patient at that time revealed retained stones on either intraoperative or postoperative cholangiograms. In none of the patients studied was the exact nature of the obstruction appreciated by the clinical and laboratory data available. All patients revealed biliary duct dilatation on ultrasound, and the majority demonstrated a bile duct calculous as well. Based on our experience, we do not recommend that ultrasonic scanning be substituted for oral or intravenous cholangiography when the latter can be performed. Nor should ultrasonic scanning be used to replace endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, or even liver biopsy if these procedures are indicated and can be completed with a reasonable degree of safety. However, we have found that ultrasound can be very helpful in the occasional patient whose biliary tract obstruction defies exact diagnosis when routine dye studies and invasive diagnostic procedures are neither accurate nor feasible.