Iatrogenic bile duct Injury with a retained T-tube in common bile duct for 10 years: A case report.

RATIONALE

Bile duct injury (BDI), a major complication of cholecystectomy, usually needs hepaticojejunostomy or primary repair over T-tube in severe cases. There were few cases about retained fragments of T-tube. Whereas, intact T-tube retained in common bile duct (CBD) for years after BDI was very rare.

PATIENT CONCERNS

A 55-year-old female complaining of a retained T-tube in the right upper quadrant for 10 years with bilious exudation for 3 months.

DIAGNOSIS

Based on the medical history of reoperation after the initial laparoscopic cholecystectomy (LC), the retained T-tube, the bilious exudation, and the feature of image modalities, she was diagnosed with retained biliary T-tube, biliary leak, hepatolithiasis, and BDI.

INTERVENTIONS

After nonsurgical management at local hospitals, the patient had her indwelling T-tube removal during laparotomy in our center finally. During this procedure, bile duct exploration, hilar bile ducts reconstruction, and primary Roux-en-Y hepaticojejunostomy were performed.

OUTCOMES

Unfortunately, bile leakage occurred postoperatively. After drainage of the peritoneal bilious fluid, the patient recovered gradually without further complication.

LESSONS

T-tube in CBD could act as nidus for stone formation after long-time placement. As a result of gradual stone formation on T-tube, severe hepatic ducts dilatation may occur without the presence of jaundice. Timely follow-up and proper surgical intervention should be suggested for patients with T-tube placement or iatrogenic BDI to avoid further impacts.