A T-tube cholangiogram is an x-ray of the biliary ducts that uses a T-tube port placed in the common bile duct after gallbladder surgery. The procedure involves injecting contrast through the T-tube port under fluoroscopy to view the bile ducts and detect any stones, strictures, or other abnormalities. It is commonly performed after gallbladder removal to check for remaining stones. The contrast is injected using either a syringe directly connected to the T-tube for liver transplant patients or a butterfly needle inserted into the T-tube tubing for other patients. Standard x-ray views are taken as the contrast fills the bile ducts.

1. T-Tube Cholangiogram

2. What is a T-Tube Cholanigogram? A T-tube cholangiogram is an x-ray of the biliary ducts. An external port that is placed into the common bile duct and extends to the outside of the body. The port is an easy access to allow for drainage of bile and stones from the bile ducts and for injecting contrast to view the ducts.

3. T-Tube

4. Why is a T-Tube Cholangiogram performed? Reveal any choleliths (stones) not previously detected. Demonstrate any small lesions, strictures, or dilatations in biliaryducts. To investigate the biliarytract. This exam can show blockages within your 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.

6. What supplies are needed? Patients with liver transplant: Water soluble contrast (Isovue 30) IV tubing connected to bottle 18 g needle 20 cc syringe Run Conray through tubing to clear air Non-liver transplant patients: Materials Needed Water soluble contrast (Isovue 30) 18, 19 or 20 g butterfly needle 50 cc syringe IV tubing Run Conray through tubing to clear air

7. Routine radiographic projections AP - 10 x 12 crosswise: 2-on-1 exposure Oblique - 10 x 12 crosswise: 2-on-1 exposure Lateral - 10 x 12 crosswise: 2-on-1 exposure

8. Specifics of Procedure Scout view of upper abdomen After the preliminary radiograph of the abdomen, the patient is put into the RPO position (AP oblique projection) with the RUQ of the abdomen centered to the center of the grid. For patients with liver transplant : T-tube: Directly connect the 20 cc syringe to the end of the t-tube. For non-liver transplant patients: Insert butterfly needle into t-tube rubber tubing Under fluoroscopy, start to instill contrast and image the CHD and CBD as they fill. Attempt to demonstrate patency of the distal duct as contrast passes into the duodenum Observe the ductal system to determine if there is any leakage of contrast from the ducts. Get a post-procedure overhead supine view with ducts filled with contrast.