The stem
A patient has had an open exploration of the common bile duct to remove stones. On day 8 you are asked about this piece of equipment in the patient’s abdomen.
The equipment
The examiner’s questions
Question 1What is this, and what is it used for?Show the model answer
A T-tube (Kehr’s tube). The short limbs sit inside the common bile duct after it has been explored and the long limb comes out through the abdominal wall to a drainage bag. It drains and decompresses the duct while the duct heals and the swelling settles.
Question 2Why is it made of latex?Show the model answer
Latex causes an inflammatory reaction, so a fibrous track forms around the long limb. When the tube is removed, bile flows along the track to the outside instead of leaking into the peritoneal cavity.
Question 3How do you decide when to remove it?Show the model answer
A T-tube cholangiogram, usually at 7 to 10 days, shows whether the duct is clear of stones and contrast flows freely into the duodenum. The tube can then be clamped and, if the patient stays well, removed once the track has matured, usually after about two weeks or later.
Question 4What are the complications?Show the model answer
Bile leak and bile peritonitis, especially if it is removed before the track has formed; accidental dislodgement; cholangitis; loss of fluid and electrolytes from high bile output; and retained stones seen on the cholangiogram.
After you answerThe teaching pointShow
T-tubes are seen less often now because stones are usually cleared by ERCP, or the duct is closed primarily after laparoscopic exploration, but they remain a favourite OSCE question.
The drawings were made for this site. The patients are written for teaching and are not real.