Case Report
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Multiple Common Bile Duct and Gallbladder Stones Treated with T-Tube Drainage

Year 2023, Volume: 1 Issue: 2, 57 - 60, 22.06.2023

Deniz Öcal

Abstract

This case report presents the treatment process with T-tube drainage of a patient with multiple common bile duct and gallbladder stones. A twenty-nine-year-old female had abdominal pain, nausea, and vomiting for about three days. The patient had twice a history of removing common bile duct stones with endoscopic retrograde cholangiopancreatography (ERCP). She had right upper quadrant pain and defence on deep palpation on the physical examination of the abdomen. In the laboratory, she had increased a c-reactive protein level (CRP) (9.4 mg/L) and a gamma-glutamyl transferase level (65 U/L). Magnetic resonance cholangiopancreatography (MRCP) showed multiple calculi on the gall bladder and common bile duct. Surgery was planned for the patient because of the large number of stones in the common bile duct. The surgery started laparoscopically, but laparotomy was performed due to laparoscopic difficulty. Seven stones were removed from the common bile duct, and a T-tube was placed in the common bile duct. Since contrast extravasation and obstructive pathology were not detected in T-tube cholangiography performed on the 15th postoperative day, the T-tube was removed. The patient was discharged on the 17th postoperative day without complications.

Keywords

Cholangiographies Cholelithiasis common bile duct

References

  • Kalayci T. Differences between groups with and without morbidity in cholecystectomy. Cukurova Med J. 2021;46(3):1077-85. DOI: 10.17826/cumj.910107
  • Sigmon DF, Dayal N, Meseeha M. Biliary Colic. StatPearls [Internet]: StatPearls Publishing; 2020.
  • Molvar C, Glaenzer B, editors. Choledocholithiasis: evaluation, treatment, and outcomes. Semin Intervent Radiol. 2016;33(4):268-276. DOI: 10.1055/s-0036-1592329
  • Moseley RH. Liver and biliary tract. Curr Opin Gastroenterol. 2003;19(3):181-4. DOI: 10.1097/00001574-200305000-00001
  • Kalayci T, Öçal D. Rectangular shaped common bile duct stone in an 83-year-old woman treated with choledochotomy with T-tube drainage. Int Med 2021; 3(4): 135-141. DOI: 10.5455/im.84417
  • Peng W, Sheikh Z, Paterson-Brown S, Nixon S. Role of liver function tests in predicting common bile duct stones in acute calculous cholecystitis. Br J Surg. 2005;92(10):1241-7. DOI: 10.1002/bjs.4955
  • Lambou-Gianoukos S, Heller SJ. Lithogenesis and bile metabolism. Surg Clin North Am. 2008;88(6):1175-94. DOI: 10.1016/j.suc.2008.07.009
  • Abboud P-AC, Malet PF, Berlin JA, et al. Predictors of common bile duct stones prior to cholecystectomy: a meta-analysis. Gastrointestinal endoscopy. 1996;44(4):450-7. DOI: 10.1016/s0016-5107(96)70098-6
  • Yıldız HK, Şahin G, Ekin EE, Erok B, Adaş GT. Safra yolu obstrüksiyonunda manyetik rezonans kolanjiopankreatografinin tanıya katkısı: Ek bulgular ve yanılgılar. JAREM. 2017;7(3). DOI: 10.5152/jarem.2017.1371
  • Boys JA, Doorly MG, Zehetner J, Dhanireddy KK, Senagore AJ. Can ultrasound common bile duct diameter predict common bile duct stones in the setting of acute cholecystitis? Am J Surg. 2014;207(3):432-5. DOI: 10.1016/j.amjsurg.2013.10.014
  • Griffin N, Charles-Edwards G, Grant LA. Magnetic resonance cholangiopancreatography: the ABC of MRCP. Insights Imaging. 2012;3(1):11-21. DOI: 10.1007/s13244-011-0129-9
  • Kaltenthaler EC, Walters SJ, Chilcott J, Blakeborough A, Vergel YB, Thomas S. MRCP compared to diagnostic ERCP for diagnosis when biliary obstruction is suspected: a systematic review. BMC Med Imaging. 2006;6(1):1-15. DOI: 10.1186/1471-2342-6-9
  • Aslan F, Arabul M, Celik M, Alper E, Unsal B. The effect of biliary stenting on difficult common bile duct stones. Prz Gastroenterol. 2014;9(2):109-15. DOI: 10.5114/pg.2014.42507
  • Baiu I, Hawn MT. Choledocholithiasis. JAMA. 2018;320(14):1506. DOI: 10.1001/jama.2018.11812
  • Hochberger J, Tex S, Maiss J, Hahn E. Management of difficult common bile duct stones. Gastrointest Endosc Clin N Am. 2003;13(4):623-34. DOI: 10.1016/s1052-5157(03)00102-8
  • Zhang J-F, Du Z-Q, Lu Q, Liu X-M, Lv Y, Zhang X-F. Risk factors associated with residual stones in common bile duct via T tube cholangiography after common bile duct exploration. Medicine (Baltimore). 2015;94(26):e1043.
  • Ozcan N, Kahriman G, Karabiyik O, Donmez H, Emek E. Percutaneous management of residual bile duct stones through T-tube tract after cholecystectomy: a retrospective analysis of 89 patients. Diagn Interv Imaging. 2017;98(2):149-53. DOI: 10.1016/j.diii.2016.05.007
  • Khan AZ, Mahmood S, Khan M, Farooq MQ. Comparison of primary repair versus T-tube placement after CBD exploration in the management of choledocholithiasis. PJMHS. 2017;11:585-8.
  • Wu X, Yang Y, Dong P, Gu J, Lu J, Li M, et al. Primary closure versus T-tube drainage in laparoscopic common bile duct exploration: a meta-analysis of randomized clinical trials. Langenbecks Arch Surg. 2012;397(6):909-16. DOI: 10.1007/s00423-012-0962-4
  • Abdulraheem OA, Amer IA, Sayed SE. Primary closure versus T-tube drainage for calculus obstructive jaundice. Egyptian J Surg. 2021;40(2):656-62.
  • Wu J, Soper N. Comparison of laparoscopic choledochotomy closure techniques. Surg Endosc. 2002;16(9):1309-13. DOI: 10.1007/s004640080016
  • Maghsoudi H, Garadaghi A, Jafary GA. Biliary peritonitis requiring reoperation after removal of T-tubes from the common bile duct. Am J Surg. 2005;190(3):430-3. DOI: 10.1016/j. amjsurg.2005.04.015
  • Wills VL, Gibson K, Karihaloo C, Jorgensen JO. Complications of biliary T‐tubes after choledochotomy. ANZ J Surg. 2002;72(3):177-80. DOI: 10.1046/j.1445-2197.2002.02308.x

T-Tüp Drenajı ile Tedavi Edilen Çoklu Ana Safra Kanalı ve Safra Kesesi Taşları

Year 2023, Volume: 1 Issue: 2, 57 - 60, 22.06.2023

Deniz Öcal

Abstract

Bu vaka raporu, çok sayıda koledok ve safra kesesi taşı olan bir hastanın T-tüp drenajı ile tedavi sürecini sunmaktadır. Yirmi dokuz yaşında bir kadında yaklaşık üç gündür karın ağrısı, mide bulantısı ve kusma vardı. Hastanın iki kez endoskopik retrograd kolanjiyopankreatografi (ERKP) ile koledok taşlarını çıkarma öyküsü vardı. Karın fizik muayenesinde sağ üst kadran ağrısı ve derin palpasyonda defans vardı. Laboratuvarda c-reaktif protein (CRP) (9.4 mg/L) ve gama-glutamil transferaz (65 U/L) düzeyleri yükseltmişti. Magnetik rezonans kolanjiyopankreatografi (MRKP)’de safra kesesi ve ana safra kanalında çok sayıda taş vardı. Ana safra kanalında taş çokluğu nedeniyle hastaya cerrahi planlandı. Ameliyat laparoskopik olarak başladı, ancak laparoskopi zorluğu nedeniyle laparotomi yapıldı. Ortak safra kanalından yedi taş çıkarıldı ve ana safra kanalına bir T-tüp yerleştirildi. Postoperatif 15. günde yapılan T-tüp kolanjiyografide kontrast ekstravazasyonu ve obstrüktif patoloji saptanmadığı için T-tüp çıkarıldı. Hasta postoperatif 17. günde komplikasyonsuz olarak taburcu edildi.

Keywords

Kolanjiyografiler Kolelitiazis ortak safra kanalı

References

  • Kalayci T. Differences between groups with and without morbidity in cholecystectomy. Cukurova Med J. 2021;46(3):1077-85. DOI: 10.17826/cumj.910107
  • Sigmon DF, Dayal N, Meseeha M. Biliary Colic. StatPearls [Internet]: StatPearls Publishing; 2020.
  • Molvar C, Glaenzer B, editors. Choledocholithiasis: evaluation, treatment, and outcomes. Semin Intervent Radiol. 2016;33(4):268-276. DOI: 10.1055/s-0036-1592329
  • Moseley RH. Liver and biliary tract. Curr Opin Gastroenterol. 2003;19(3):181-4. DOI: 10.1097/00001574-200305000-00001
  • Kalayci T, Öçal D. Rectangular shaped common bile duct stone in an 83-year-old woman treated with choledochotomy with T-tube drainage. Int Med 2021; 3(4): 135-141. DOI: 10.5455/im.84417
  • Peng W, Sheikh Z, Paterson-Brown S, Nixon S. Role of liver function tests in predicting common bile duct stones in acute calculous cholecystitis. Br J Surg. 2005;92(10):1241-7. DOI: 10.1002/bjs.4955
  • Lambou-Gianoukos S, Heller SJ. Lithogenesis and bile metabolism. Surg Clin North Am. 2008;88(6):1175-94. DOI: 10.1016/j.suc.2008.07.009
  • Abboud P-AC, Malet PF, Berlin JA, et al. Predictors of common bile duct stones prior to cholecystectomy: a meta-analysis. Gastrointestinal endoscopy. 1996;44(4):450-7. DOI: 10.1016/s0016-5107(96)70098-6
  • Yıldız HK, Şahin G, Ekin EE, Erok B, Adaş GT. Safra yolu obstrüksiyonunda manyetik rezonans kolanjiopankreatografinin tanıya katkısı: Ek bulgular ve yanılgılar. JAREM. 2017;7(3). DOI: 10.5152/jarem.2017.1371
  • Boys JA, Doorly MG, Zehetner J, Dhanireddy KK, Senagore AJ. Can ultrasound common bile duct diameter predict common bile duct stones in the setting of acute cholecystitis? Am J Surg. 2014;207(3):432-5. DOI: 10.1016/j.amjsurg.2013.10.014
  • Griffin N, Charles-Edwards G, Grant LA. Magnetic resonance cholangiopancreatography: the ABC of MRCP. Insights Imaging. 2012;3(1):11-21. DOI: 10.1007/s13244-011-0129-9
  • Kaltenthaler EC, Walters SJ, Chilcott J, Blakeborough A, Vergel YB, Thomas S. MRCP compared to diagnostic ERCP for diagnosis when biliary obstruction is suspected: a systematic review. BMC Med Imaging. 2006;6(1):1-15. DOI: 10.1186/1471-2342-6-9
  • Aslan F, Arabul M, Celik M, Alper E, Unsal B. The effect of biliary stenting on difficult common bile duct stones. Prz Gastroenterol. 2014;9(2):109-15. DOI: 10.5114/pg.2014.42507
  • Baiu I, Hawn MT. Choledocholithiasis. JAMA. 2018;320(14):1506. DOI: 10.1001/jama.2018.11812
  • Hochberger J, Tex S, Maiss J, Hahn E. Management of difficult common bile duct stones. Gastrointest Endosc Clin N Am. 2003;13(4):623-34. DOI: 10.1016/s1052-5157(03)00102-8
  • Zhang J-F, Du Z-Q, Lu Q, Liu X-M, Lv Y, Zhang X-F. Risk factors associated with residual stones in common bile duct via T tube cholangiography after common bile duct exploration. Medicine (Baltimore). 2015;94(26):e1043.
  • Ozcan N, Kahriman G, Karabiyik O, Donmez H, Emek E. Percutaneous management of residual bile duct stones through T-tube tract after cholecystectomy: a retrospective analysis of 89 patients. Diagn Interv Imaging. 2017;98(2):149-53. DOI: 10.1016/j.diii.2016.05.007
  • Khan AZ, Mahmood S, Khan M, Farooq MQ. Comparison of primary repair versus T-tube placement after CBD exploration in the management of choledocholithiasis. PJMHS. 2017;11:585-8.
  • Wu X, Yang Y, Dong P, Gu J, Lu J, Li M, et al. Primary closure versus T-tube drainage in laparoscopic common bile duct exploration: a meta-analysis of randomized clinical trials. Langenbecks Arch Surg. 2012;397(6):909-16. DOI: 10.1007/s00423-012-0962-4
  • Abdulraheem OA, Amer IA, Sayed SE. Primary closure versus T-tube drainage for calculus obstructive jaundice. Egyptian J Surg. 2021;40(2):656-62.
  • Wu J, Soper N. Comparison of laparoscopic choledochotomy closure techniques. Surg Endosc. 2002;16(9):1309-13. DOI: 10.1007/s004640080016
  • Maghsoudi H, Garadaghi A, Jafary GA. Biliary peritonitis requiring reoperation after removal of T-tubes from the common bile duct. Am J Surg. 2005;190(3):430-3. DOI: 10.1016/j. amjsurg.2005.04.015
  • Wills VL, Gibson K, Karihaloo C, Jorgensen JO. Complications of biliary T‐tubes after choledochotomy. ANZ J Surg. 2002;72(3):177-80. DOI: 10.1046/j.1445-2197.2002.02308.x
There are 23 citations in total.

Details

Primary Language English
Subjects Surgery
Journal Section Case Report
Authors

Deniz Öcal 0000-0002-8084-8866

Early Pub Date June 22, 2023
Publication Date June 22, 2023
Submission Date March 2, 2023
Published in Issue Year 2023 Volume: 1 Issue: 2

Cite

AMA Öcal D. Multiple Common Bile Duct and Gallbladder Stones Treated with T-Tube Drainage. Ağrı Med J. June 2023;1(2):57-60.
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