T- Tube Cholangiogram

                  T – Tube Cholangiogram

Definition

A T-tube cholangiogram is a radiographic procedure done after a patient’s gallbladder has been removed and a surgeon has placed a T- tube in the patient’s right side to drain the bile ducts.

Indications

To check the patency of T- tube

Haemorrhage from the t-tube.

Bile duct stricture

Contrast

The contrast is used is urographin60% which is diluted with normal saline in 1:3 ratio. 

Risk Factors

Allergy to contrast

Biliary peritonitis

Biliary fistula

Cholangitis

Equipments

X ray unit

Fluoroscopy with spot film device

Syringe

Urographin 

Surgical gloves and betadine 

Preparation

The procedure should be explained to patient before undergoing procedure.

All metallic ornaments should be removed specially in the abdomen region.

Ask for any history of contrast reaction

Take previous history.

Take consent form

Patient Identification ( correct patient, correct side correct procedure)

Procedure

The patient lies supine on the table and the plain film is taken

Using sterile technique first of all the tip of the T – tube is cleaned with betadine

Then the contrast is injected into the t- tube under fluoroscopic guidance and spot films are taken.

The first 5ml of the contrast is injected and images are taken this shows a biliary tree.

Then the rest of the contrast is injected into the tube and other image are taken this shows passage of contrast into the duodenum.

Filming

Plain film abdomen AP (supine)

After contrast :- 

abdomen ap after 5ml contrast 

abdomen ap after whole contrast is injected.

Then delayed film if required.

Case :  

A: Postero-anterior T-tube cholangiogram showing biliary tract mal-repair (arrowhead indicates the T-tube, arrow indicates the tube drain)

 B: Schematic diagram of the cholangiogram. 

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