Bile Peritonitis associated with Biliary Leakage after Removal of T-tube from Common Bile Duct / 한국간담췌외과학회지

ABSTRACT

BACKGROUND: It is common practice for surgeons to place a T-tube after common bile duct exploration. T-tubes are regarded as safe and they allow postoperative cholangiography. But the unexpected cases of bile peritonitis after T-tube removal raised questions of common factors in etiology. The aim of this study is to investigate risk factors of biliary leakage after removal of T-tube from common bile duct. Materials and METHODS: Seven cases of biliary leakage after removal of T-tube have been experienced in Department of Surgery of Chonnam National University Hospital from January 1988 to March 2000. Seven cases were investigated with respect to the following parameters presenting disease, underlying disease, laboratory findings, nutritional status, findings associate with T-tube, clinical findings and the results of treatments. RESULTS: The mean age of the patients was 62.9years(range, 45-77years). The presenting diseases were CBD stone with GB stone in three cases, CBD stone in two cases, IHBD stone in two cases. Previous medical history was unremarkable with the exceptions of one hypertensive patient and one patients with early gastric cancer concurrently undergoing treatment for hypertrophic cardiomyopathy. The mean body mass index(BMI) of the patients was 20.5. Arterial blood gas analyses and pulmonary function tests were normal. Preoperative laboratory findings were unremarkable except one patient of hypoalbuminemia. Liver function tests were normal, except in one patient with toxic hepatitis. In all cases, silastic T-tube was inserted following cholecystectomy and choledocholithotomy. The mean CBD diameter was 16.4mm (range, 12-21mm). CBD repair was done with absorbable sutures. Postoperative T-tube cholangiography revealed a remnant stone in the patients with the left intrahepatic stone and were unremarkable in all other cases. The T-tube was removed after a mean duration of 24.6days(range, 15-53). The abdomial pain and tenderness in all patients, most frequently in the right upper qudrant, was the significant sign and symptom associated with bile leakage. The symptoms resolved in four of five patients by drainage using a nelaton tube. The remaining patients(n=3) underwent reinsetion of T-tube. CONCLUSIONS: It is very difficult to predict the occurrence of bile leakage after T-tube removal. And early diagnosis and immediate percutaneous drainage make a good result in patient with localized peritonitis.