Combined use of percutaneous transhepatic cholangiography (P.T.C.) and endoscopic ampullary cholangiography in the diagnosis of "difficult" jaundice cases.

When bilirubin levels are elevated, visualization of the biliary ducts is only possible by endoscopic transampullary cholangiography or by P.T.C. Cannulation of the biliary tree is difficult under the best of circumstances and when obstruction exists at the caudal end of the ducts, success is frequently precluded. P.T.C. then becomes the modality of choice, since visualization can be achieved in 98% of cases when obstruction exists. These methods are complementary. Each should be used when the other fails. Their dual application and complementary role in "difficult" jaundice cases is elaborated upon in the 16 cases reported in this current series. Their combined use should help elicit the diagnosis in almost all cases of jaundice.