Bile peritonitis after removal of T-tubes from the common bile duct

Abstract

Bile peritonitis can occur when a T-tube is electively removed from the common bile duct, but this is regarded as a rare complication. Plastic T-tubes are known to increase the risk and should not be used. Latex rubber T-tubes are preferred but the complication can still occur. We present three patients with this complication despite the use of a latex T-tube. A questionnaire was sent to 107 surgeons in the South East Thames Region. The replies showed that the complication is far more common than generally realized. Based on these replies the risk of bile peritonitis each time a latex T-tube is electively removed from the common bile duct is calculated to be 0.84 per cent or 1 in every 119 explorations.

Closure of the Common Duct -Endonasobiliary Drainage Tubes vs. T Tube: A Comparative Study

“…These may be displacement, biliary sepsis, thromboembolism, electrolyte and fluid losses, wound infections, pancreatitis and obstructive jaundice [1][2][3][4][5][6]. Biliary leaks have been shown to occur at the time of tube removal or at cholangiography [8] which may progress to intraperitoneal collections, external fistulae or even peritonitis [9][10][11]. The CBD may even be traumatized at the time of removal [13] with possible fibrosis and stricture.…”

“…Two of these patients had intraperitoneal collections and the other biliary peritonitis. Bile leaks following removal of the T tube are well documented in literature and although many reasons have been elaborated to try to explain them including choice of material [9,29,30] shape of the T tube [9,31] suture material, [10,28,33,34] surgical technique [35] and the time of removal [11,36] no consistent opinion has been found to hold true in all studies. Thus the actual cause still probably remains elusive.…”

“…They blamed the PVC material for the leaks, which was thought to be more inert. PVC hardens when it comes into contact with bile [9,29] and this further traumatizes the CBD at time of removal. For this reason latex T tubes were recommended however in 1971 Osborn thought latex washed with silicone to be the responsible for 3 cases of leak in his study [30].…”

“…It allows a post operative cholangiography and forms a route for the management of residual stones. The T tube is however associated with possible complications which may at times be serious, besides prolonging the hospital stay [4][5][6][7][8][9][10][11].…”

Case-based review: bile peritonitis after T-tube removal

“…5,6 However, prospective trials involving latex T-tubes have also shown cases of bile peritonitis after their removal. 7 It is considered safe to remove latex T-tubes at 7-10 days. 7 However, other authors prefer to leave latex T-tubes in for 21 days.…”