What Is an Intraoperative Cholangiogram?

Medically Reviewed by Minesh Khatri, MD on January 27, 2022

Your liver makes bile, a chemical that helps you digest food. The plumbing system of ducts that runs between your liver, gallbladder, and small intestine is how bile moves around. Some of it goes right to work in your small intestine. The rest gets stored in your gallbladder.

An intraoperative cholangiogram is a special kind of X-ray imaging that shows those bile ducts. It's used during surgery. With a typical X-ray, you get one picture. But a cholangiogram shows your doctor a live video of your bile ducts so they can see what's happening in real-time.

How It Can Help

Typically, cholangiogram is used when you have gallstones and need your gallbladder removed. Your doctor will make a few small cuts in your body (called laparoscopic surgery). Then they'll put a tiny video camera through one of the cuts to help him with the operation.

During this surgery, an intraoperative cholangiogram may help your doctor do the following:

Check for bile duct stones. Stones in your gallbladder sometimes move into your bile ducts. They don't always cause symptoms, but they can lead to serious problems such as an infection.

Keep the common bile duct safe. You have a lot of ducts, organs, and other parts packed tightly in this part of your body. Sometimes your doctor can't tell what they're looking at. So there's a chance they could harm one of your biggest ducts, the common bile duct.

When You Might Need One

You're more likely to get one during surgery if you have:

  • A history of jaundice or pancreatitis
  • Liver function that's higher than normal
  • Several small gallstones
  • A wider-than-normal common bile duct or cystic duct
  • Bile duct stones, or lab results that tell your doctor you might have them

How It's Done

When it's time to get imaging during surgery, your doctor will:

  • Put a clip on the cystic duct, which runs right into your gallbladder. This stops anything from flowing in or flowing out.
  • Then, put a thin tube into the cystic duct.
  • Push a contrast dye into the tube, which helps highlight the bile ducts.
  • Take live X-rays with a tool called a fluoroscope.

Possible Risks

The main ones include:

Allergic reaction: The dye used for the imaging may give you problems. Tell your doctor about any past reactions you've had to contrast dyes, iodine, latex, or medicines.  

Wrong results: Your doctor may call them a false positive. It might look like you have bile duct stones, but you really don't. Then you might get care you don't need, which could cause problems.

Injury: There's a chance that the process could damage bile ducts or nearby body parts.

Radiation: Talk to your doctor about how much radiation you'll get during the procedure. Also tell him about any scans or treatments with radiation you've had in the past. If you're pregnant or think you might be, tell your doctor. Radiation can harm your baby. 

Show Sources


Johns Hopkins Medicine: "Biliary System: Anatomy and Functions," "Fluoroscopy Procedure."

PeaceHealth Medical Centers: "Cholangiogram."

Society of American Gastrointestinal and Endoscopic Surgeons: "Clinical Spotlight Review: Intraoperative Cholangiogram."

International Journal of Surgery, Volume 8, Issue 8, 2010, pp. 602-605: "Role of Intra Operative Cholangiogram in current day practice."

University of Southern California, Department of Surgery: "What Is Laparoscopic Surgery."

Journal of the Society of Laproendoscopic Surgeons, April-June 2000: "The Importance of Intraoperative Cholangiography during Laparoscopic Cholecystectomy."

NIH, National Institute of Diabetes and Digestive and Kidney Diseases: "Gallstones."

Journal of the American Medical Association, Volume310, Issue 8, August 28, 2013: "Laparoscopic Cholecystectomy, Intraoperative Cholangiograms, and Common Duct Injuries."

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