T-tube cholangiogram.

What is T-tube cholangiogram?

A T-tube cholangiogram is a fluoroscopic procedure in which contrast medium is injected through a T-tube into the patient’s biliary tree. The T-tube is most commonly inserted during a cholecystectomy operation when there is a possibility of residual gall stones within the biliary tree.

Indications:
1. to exclude biliary tract calculi where :
(a) operative cholangiography was not performed or
(b) the results of operative cholangiography are not satistactory

2. Assessment of biliary leaks following biliary surgery.

Contraindications : None

Contrast medium : HOCM or LOCM 150; 20-30 ml.

Equipment : Fluoroscopy unit with spot film device.

Patient preparation :

• patient identification (3 Cs- correct patient, correct side, correct procedure)
• Patient should be wearing a hospital gown
• consent form
• no diet restrictions (some centres suggest fast from solids for 4 hours prior to procedure)
• collect relevant previous imaging for ease of access prior to procedure
• ? prophylactic dose of broad spectrum antibiotic prior to procedure (immunosupressed patients)
• Some operators prefer the T-tube to be clamped prior to the procedure to allow the bile duct to fill with bile. Air in the bile duct can give a false impression of a gallstone.

Preliminary film : Coned supine PA of the right side of the abdomen.

Technique :
1. The examination is performed on or about the tenth postoperative day,prior to pulling out the T-tube.
2. The patient lies supine on the x-ray table. A slightly RPO position can help to ensure the CBD is not superimposed over the patient’s spine. The drainage tube is clamped and tip is cleaned thoroughly with antiseptic.
3. A 23-G needle, extension tubing and 20ml syringe are assembled and filled with contrast medium. The T-tube should be raised and tapped to ensure there are no air bubbles lurking in the tube. After all air bubbles have been expelled, the needle is inserted into the tubing between the patient and the clamp. The injection is made under fluoroscopic control, the total volume depending on duct filling.
4. The entire biliary tree should be imaged during injection of contrast medium.Injection should continue until the entire biliary tree is opacified and there is passage of contrast into the duodenum.If the intrahepatic ducts do not fill, the patient can be tilted trendelenburg and further contrast injected into the T-tube.The patient may need to lie on their left hand side to fill the left hepatic duct.

Films : PA and oblique view under fluoroscopic control.

This is an AP/PA supine T-tube cholangiogram image. The biliary tree is outlined with contrast medium. It appears to be extravasation of contrast medium outside the biliary tree and minimal contrast in the duodenum.

Aftercare : None.

Complications:

Due to contrast medium : The biliary ducts do absorb contrast medium and cholangiovenous reflux can occur with high injection pressures.Adverse reactions are therefore possible but the incidence is small.

Due to technique : Injection of contrast medium under high pressure into an obstructed biliary tract can produce septicaemia.

Patient’s Information :

Preparation

Tell the technologist if you have any allergies (especially to iodine or seafood).
You will be asked to sign a consent form.
Your doctor will order food or fluid restrictions before the test.
Do not wear jewelry to your appointment.

Procedure :

You will be asked to put on a hospital gown.
You will be on an x-ray table as the radiologist injects x-ray contrast into the T-Tube.
You will be asked to hold your breath as the x-rays are taken.
You may feel a bit of pressure as the dye is injected.
The procedure takes approximately 15-30 minutes.
The dye which is colourless will drain into the drainage bag once the test is completed.

After the Test

You may eat and drink normally.
Return to your normal activity.
Contact your physician if you have pain, any itching or rash post procedure.
patient should remain in hospital for observation for at least 24 hours post procedure
If the T-tube is removed at the end of the procedure, the wound should be checked for bile leakage for 24 hours

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