Radiology Procedure (T-Tube cholangiography)

           T-TUBE CHOLANGIOGRAPHY 

-tube cholangiography is a radiologic procedure used to visualize the biliary tree (bile ducts) postoperatively using a T-tube that is temporarily left in place following bile duct surgery, usually after common bile duct (CBD) exploration.


🔹 Definition

T-tube cholangiography is an imaging technique that uses contrast media injected through a T-tube catheter placed in the common bile duct to assess for residual stones, strictures, or bile leaks postoperatively.

🔹 Indications

  • Evaluate patency of the biliary ducts after bile duct surgery
  • Detect residual CBD stones
  • Assess for bile leaks
  • Check for strictures or tumors in the biliary tree
  • Confirm ductal anatomy before T-tube removal

🔹 Contraindications

  • Allergy to iodinated contrast media
  • Infection (cholangitis) – must be controlled first
  • Inability to cooperate (e.g., severely agitated or confused patients without sedation or support)
  • Biliary obstruction with high pressure that could cause bile reflux

🔹 Patient Preparation

  • Fasting (NPO) for at least 6 hours before the procedure
  • Review allergy history (especially to iodine/contrast media)
  • Ensure T-tube is functioning and not blocked
  • Obtain informed consent
  • May administer antibiotic prophylaxis if risk of infection is high
  • Baseline liver function tests (LFTs) may be checked

🔹 Contrast Used

  • Water-soluble iodinated contrast medium, e.g.:
    • Iohexol (Omnipaque)
    • Iopamidol
  • Diluted with sterile saline to reduce viscosity

🔹 Method (Procedure Steps)

  1. Patient lies in supine position on X-ray table.
  2. The T-tube is flushed with sterile saline to ensure patency.
  3. Diluted contrast is slowly injected through the T-tube under fluoroscopy.
  4. Real-time imaging captures the filling of the biliary tree (biliary track).
  5. If necessary, oblique and delayed films are taken to detect stones or leaks.

🔹 Films Taken (Imaging)

  • Initial scout film (non-contrast)
  • AP view (anteroposterior)
  • Oblique views (to separate overlapping ducts)
  • Delayed films (if stone passage or leak suspected)
  • Post-procedural film to check for complications

🔹 Aftercare

  • Observe the patient for signs of:
    • Contrast reaction
    • Pain
    • Infection (fever, chills)
  • Encourage oral fluids after the procedure
  • If normal study: T-tube may be clamped or removed in 24–48 hours
  • Maintain sterile dressing at the tube site

🔹 Diseases Diagnosed by T-tube Cholangiography

  • Residual or recurrent CBD stones
  • Bile duct strictures
  • Biliary leaks
  • Choledochal cysts
  • Tumors (cholangiocarcinoma)
  • Sclerosing cholangitis.

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