T-Tube Breakage During Removal: Management by Endoscopic Retrograde Cholangiopancreatography/T-Tupun Cikarilmasi Sirasinda Kopmasi: Endoskopik Retrograd Kolanjiyopankreatografi ile Yonetimi

• Published in: Journal of academic research in medicine 2020-12, Vol.10 (3), p.294
• Main Authors: Kirmaci, Mehlika Bilgi, Akay, Tamer, Ozgül, Esra, Yilmaz, Sezgin
• Format: Article
• Language: English
• Subjects: Case studies; Complications; Complications and side effects; Drainage, Surgical; Endoscopic retrograde cholangiopancreatography; Methods; Surgery
• ISSN: 2146-6505
• DOI: 10.4274/jarem.galenos.2020.3354

T-tube drainage is a widely used procedure among surgeons for various biliary conditions. However, various complications may occur, especially due to the breaking-off of the T-tube from the area where it enters the common bile duct during retraction. These complications often require subsequent surgical procedures to remove the T-tube fragment from the common bile duct lumen. In selected cases, the T-tube fragment can be extracted from the common bile duct by endoscopic retrograde cholangiopancreatography (ERCP). ERCP has a life-saving role that eliminates reoperation for such a complication. Herein, we present a 42-year-old female patient who was referred to our hospital, which is as an advanced center, due to breakage during T-tube withdrawal. The patient had previously undergone open cholecystectomy and T-tube drainage. When removing the T-tube, a breakage occurred at 3-4 cm from the T-tube leg, which was left in the common bile duct. In the ERCP, the leg of the T-tube was removed from the common bile duct lumen by basket compression following endoscopic sphincterotomy and a temporary plastic stent was placed. One month after the procedure, the stent was removed with the help of the ERCP. This case is presented as a rare indication of ERCP. Keywords: Cholangiopancreatography, endoscopic retrograde, drainage, T-tube, complications T-tüp drenaji cerrahlar arasindaki çesitli biliyer problemler için yaygin olarak kullanilan bir prosedürdür. Bununla birlikte, özellikle T-tüpün geri çekilmesi sirasinda ortak safra kanalina girdigi bölgeden kopmasi sonucunda çesitli komplikasyonlar meydana gelebilir. Bu komplikasyonlar genellikle ortak safra kanali lümeninden T-tüp fragmanini çikarmak için ardindan gelen cerrahi prosedürler gerektirebilir. Bununla birlikte seçici olgularda T-tüp fragmani, endoskopik retrograd kolanjiyopankreatografi (ERCP) ile ortak safra kanalindan çikartilabilir. ERCP, böyle bir komplikasyon için yeniden ameliyati ortadan kaldiran hayat kurtarici bir role sahiptir. Bu çalismada, T-tüpün geri çekilmesi sirasinda kopmasi nedeniyle ileri merkez olarak hastanemize sevk edilen 42 yasinda kadin hasta sunuldu. Hastaya daha önce açik kolesistektomi ve T-tüp drenaji uygulanmisti. T-tüp çikarilirken, T-tüp bacagindan 3-4 cm mesafede kopma meydana geldi. T-tüp bacagi ortak safra kanalinda kalmisti. ERCP'de T-tüpün bacagi, endoskopik sfinkterotomiyi takiben basket sikistirmasi ile ortak safra kanali lümeninden çikarildi ve geçici bir plastik stent yerle