PRESENTED BY
DR. SALEH AHMED HAMIDI
(DIPTO)
INTERN DOCTOR
HOLY FAMILY RED CRESCENT MEDICAL
COLLEGE HOSPITAL, DHAKA
T-TUBE
MANAGEMENT
WHAT IS T TUBE ?
A tubular device in the shape of a T,
inserted through the skin into a cavity or
a wound and used for drainage.
ARE SILICONE RUBBER T-TUBES BETTER THAN LATEX
RUBBER TUBES IN THE COMMON BILE DUCT?
A retrospective comparison of latex and
silicone rubber T-tubes draining the
common bile duct in the Rhesus monkey
shows that both tubes excite an adequate
local tissue reaction. [BJS , vol 61 , page 201-06]
However, latex rubber degenerated more
rapidly than silicone rubber, the interval
between insertion of the tube and onset of
complications being significantly shorter.
CONTD
It is suggested that silicone rubber T-
tubes have a place in human biliary
surgery, especially when long-term
drainage of the biliary tract is
requirred.
VARIOUS USE OF T-TUBE
T-tube Necessary after Laparoscopic /open Choledochotomy
Use of T-tube for Patients with Persistent Duodenal Fistula
Hepaticojejunostomies in the setting of liver transplantation
Pancreaticoduodenectomy
CONTD
Use of a T-tube stent to treat a patient
with tracheal stenosis.
Use of the Montgomery T tube in
ventilator-dependent patients
PURPOSE OF T TUBE
Handling of the common bile duct in the
form of dissection, dilatation or
choledochotomy invariably leads to
slowing of motility in the common bile
duct as well as can lead to spasm of the
sphincter of Oddi.
T-tube can cause back pressure and give
way of sutures used to suture the
choledochotomy incision leading to a
surgical calamity.
CONTD
The morbidity and mortality
associated with biliary peritonitis is
extremely high. Placement of a T
tube prevents all these
complications.
COMPLICATION OF T-TUBE
Complications that have been reported
may occur with the T-tube in situ. These
include
Fluid and electrolyte imbalance,
Early dislodgment,
Tube dislocation,
Tube retention,
And bacteremia
POST OPERATIVE MANAGEMENT OF T-TUBE
Drainage of bile through T-tube up to 7th POD
Position of the T-tube should maintainted
Progressive clamping of the T-tube from 8th POD
Observation of the patient during clamping for –a.Pain in abdomen b. Fever c. jaundice
Daily observation of bile flow-Quantitty of bile, color of bile , Any leakage
WHAT IS T TUBE CHOLANGIOGRAM ?
A T-tube cholangiogram is an x-ray of the biliary duct system.
These ducts transport bile between liver, gallbladder, and small intestine are not seen on radiographs without the use of contrast materials.
This contrast is injected via a T-tube, which is normally put in place during surgical procedures ranging from liver transplantation to cholcystectomy.
WHY IS A T-TUBE CHOLANGIOGRAM PERFORMED?
Reveal any choleliths (stones) not
previously detected.
Demonstrate any small lesions, strictures,
or dilatations in biliary ducts.
To investigate the biliary tract.
CONTD
This exam can show blockages within
common bile duct or hepatic ducts.
The most common reason for this exam is
to look for remaining stones or stone
fragments in the ducts after having the
gallbladder removed
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