The management of major renal lacerations after blunt trauma is still a matter of controversy. In this study, conservative treatment of major renal lacerations failed in 7 of 18 patients, leading to delayed surgery. Urography after blunt trauma was abnormal in 97% of patients with severe renal injury but a normal urogram did not exclude severe renal injury. Computed tomography had a greater degree of accuracy than urography and ultrasonography in determining the extent of the injury and was more practical to perform than angiography. The results indicate that patients with significant extrarenal leakage on urography, angiography or CT should receive immediate surgical management.

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The diagnostic value of ultrasonography and percutaneous cholangiography was compared in 114 consecutive patients with obstructive jaundice. The final diagnosis was obtained by surgery or autopsy. Transhepatic cholangiography diagnosed obstruction and its level in all patients, whereas ultrasonography failed to find obstruction in 3 patients and was unable to determine the level in 11 patients. The cause of obstruction was correctly assessed in 106 patients by transhepatic cholangiography and in 74 by ultrasonography. In 15 patients with obstruction caused by common duct calculi ultrasonography only diagnosed the five, and in 9 patients malignant obstruction was diagnosed as calculi. Ultrasonography is a reliable tool for diagnosis of obstructive jaundice and in most cases for localisation of the level of the obstruction. However, diagnosis of the cause of obstruction and of its precise topography requires direct cholangiography.

In five patients with pancreatitis, obstructive jaundice was relieved by internal drainage of the biliary tract with an endoprosthesis inserted by percutaneous transhepatic technique. The average duration of treatment was 3.5 months. The endoprosthesis were removed by means of a duodenoscope, and jaundice did not recur.