20. Cholangiogram and pancreatogram, AP projection

A catheter ending in a T-tube configuration has been intraoperatively placed with its tip in the distal common bile duct. Injection of contrast results in opacification of the bile ducts, gallbladder, and pancreatic duct. Radiopaque contrast is also seen in the stomach and duodenum.

Bile from the right and left lobes of the liver drains into the right and left hepatic ducts, respectively, which unite at the porta hepatis to form the common hepatic duct. Bile is concentrated and stored in the gall bladder, which is connected to the rest of the biliary system via the cystic duct. The common bile duct is formed by the union of the cystic and common hepatic ducts, descending in the porta hepatis anterior to the portal vein and generally to the right of the hepatic artery. It then descends through the posterior part of the pancreatic head and is joined distally by the main pancreatic duct, and the two ducts become confluent at the ampulla of Vater.