Precautions

T-tube cholangiography can be a dangerous procedure if done aggressively and without great care. Contrast media should be sterile and injected slowly and gently to avoid producing ascending cholangitis and bacteremia. There are those who believe that the test should be done only with antibiotic coverage. Others recommend using a drip infusion under gravitational forces or inserting a manometer into the injection system to help prevent overfilling of the ducts. At the very least, one should monitor the fluoroscopic image and the patient's symptoms for evidence of duct overfilling and immediately cease the injection and begin aspirating contrast if this occurs.

The signs and symptoms of overfilling to look for are:

the patient complains of RUQ fullness or pain,

reflux of contrast into the pancreatic duct ,

flow of contrast into duodenum stops because the sphincter of Oddi goes into spasm,

the bile ducts begin to dilate during the study,

peripheral 4th & 5th order radicals in the liver fill.

contrast agent flows along the outside of the long arm of the t-tube.

Ascending cholangitis and bacteremia are particularly likely to occur if the bile ducts are obstructed partially or completely by stones or tumor. Providing external drainage of bile immediately after the procedure can help prevent this complication.

NOTE: At the request of the surgeons, any t-tube cholangiogram performed on a liver transplant patient will be done with an open manometer in the injection system, and the pressure will be monitored not to exceed 30 cm of water.