Iatrogenic bile duct Injury with a retained T-tube in common bile duct for 10 years: A case report.

Authors:
MRs Li Wang, RN
MRs Li Wang, RN
shepherd university
RN
RN
walnut , CA | United States
Ping Dong
Ping Dong
Xinhua Hospital
China
Yi Zhang
Yi Zhang
Harvard Medical School
United States
Xubao Liu
Xubao Liu
West China Hospital
China
Bole Tian
Bole Tian
Sichuan University
China

Medicine (Baltimore) 2019 Apr;98(15):e15127

Department of Pancreatic Surgery.

Rationale: Bile duct injury (BDI), a major complication of cholecystectomy, usually needs hepaticojejunostomy or primary repair over T-tube in severe cases. There were few cases about retained fragments of T-tube. Whereas, intact T-tube retained in common bile duct (CBD) for years after BDI was very rare.

Patient Concerns: A 55-year-old female complaining of a retained T-tube in the right upper quadrant for 10 years with bilious exudation for 3 months.

Diagnosis: Based on the medical history of reoperation after the initial laparoscopic cholecystectomy (LC), the retained T-tube, the bilious exudation, and the feature of image modalities, she was diagnosed with retained biliary T-tube, biliary leak, hepatolithiasis, and BDI.

Interventions: After nonsurgical management at local hospitals, the patient had her indwelling T-tube removal during laparotomy in our center finally. During this procedure, bile duct exploration, hilar bile ducts reconstruction, and primary Roux-en-Y hepaticojejunostomy were performed.

Outcomes: Unfortunately, bile leakage occurred postoperatively. After drainage of the peritoneal bilious fluid, the patient recovered gradually without further complication.

Lessons: T-tube in CBD could act as nidus for stone formation after long-time placement. As a result of gradual stone formation on T-tube, severe hepatic ducts dilatation may occur without the presence of jaundice. Timely follow-up and proper surgical intervention should be suggested for patients with T-tube placement or iatrogenic BDI to avoid further impacts.

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Source
http://dx.doi.org/10.1097/MD.0000000000015127DOI Listing
April 2019
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