T- Tube Cholangiogram
What is a T Tube Cholangiogram?
Presence of stone inside the common bile duct is called Choledocholithiasis.
There are two ways of stone formation occurring in side the common bile duct. One is from the gall bladder.
The other is de novo stone formation inside the common bile duct.
The cause of de novo stone formation inside the common bile duct is Portal pyemia or cholangitis.
The stone formed as a result of portal pyemia is Brown pigment stone. Black pigment stone is formed as result of excessive haemolysis.
After the open surgical exploration for Common bile duct for choledocho lithiasis, the completion of the stone removal is not full proof, as the stone removal is a blind process.
That means, in open surgery, even after the removal of last stone from the common bile duct one is not sure that all the stones are out.
Hence a special tube called T tube is placed. The upper horizontal part of the T tube is placed inside the common hepatic duct.
The lower horizontal part of the T tube is placed inside the distal common bile duct. The vertical part of the T tube is brought out to skin surface.
If there is a distal obstruction of the common bile duct the quantity of bile coming out through the vertical limb will be more.
The normal amount of bile secreted by the liver is around 800-1000ml. Hence if the discharge through the T tube is approaching this amount it is presumed that there is distal obstruction for the bile flow.
To confirm the distal obstruction on 10th post operative day we do an
investigation called T tube cholangiogram.
In the T tube cholangiogram if the radio opaque iodine containing dye is reaching the duodenum that means there is no distal obstruction.
The left over stones are seen as the filling defects or negative shadows.
The special forceps used to remove the stones from the common bile duct is called Desjardin’s Choledocholithotomy forceps.
The dilators we use for dilating the common bile duct is called Bake’s Dilators. These are dilators with serially increasing diameters.
The latest device used in the removal of stones from the common bile duct is called Choledochoscope.
Through a Choledochoscope one can see the interior of the common bile duct as well as the common hepatic duct and all the stones can be removed under vision, making a T tube cholangiogram not mandatory.
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