Treatment of Retained Bile Duct Calculi with T-Tube Infusion of Sodium Cholate and Heparin

Abstract

A series of 26 patients with retained radiolucent bile duct calculi diagnosed at postoperative cholangiagrophy through the T-tube is presented. All patients were treated with infusion of 15-20 g sodium cholate in 1000 ml saline and 20,000 units of heparin in 1000 ml saline per 24 hours. In 19 of 26 patients (73 per cent) the calculi disappeared. No complications were encountered. This treatment is recommended prior to reoperation in all patients with retained radiolucent bile duct calculi diagnosed by postoperative cholangiography through the T-tube.

Non-operative treatment of retained bile duct calculi in patients with an indwelling T tube

“…Continuous infusion of sodium cholate alternating with heparin has been shown to be effective in 73 per cent of patients treated (Christiansen et al, 1977).…”

Treatment of retained common bile duct stones: A prospective controlled study comparing monooctanoin and heparin

“…Britton [17] reported success in 4 of 7 cases and Lansford [18] in 5 of 6. LaRusso [19] reported good results in only 2 of 6 patients; and Christiansen [20], using a combination of sodium cholate and heparin, reported 73% disappearance of calculi in a group of 26 patients. Diarrhea was the main side effect with bile salt infusion, but there are some reports of cholangitis and death due to sepsis with intrahepatic infusion [21].…”

The Medical Treatment of Gallstones

“…Successful dissolution has been reported following T-tube infusion of 25,000 USP units of heparin every eight hours (117). Sodium cholate (15-20 g) in one liter of saline alternating or in combination with 20,000 IV heparin in one liter of saline over 24 hours has been used successfully in 19 of 26 patients (118). We have had 5 successes in 15 patients receiving 100 mM sodium cholate, 2 successes in 5 patients receiving 100,000 IV heparin, and dissolution in 1 of 2 patients infused with physiological saline (119).…”