T tube sinus tract duodenal fistula: a rare complication of postoperative choledochoscopy for treating retained intrahepatic stones

Jianying Lou,Ji Wang,Wei Chen,Hua Zhao

doi:10.1007/s00464-020-08057-7

Jianying Lou, Ji Wang + Show 2 more

Open Access

https://doi.org/10.1007/s00464-020-08057-7

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Abstract

BackgroundsPostoperative percutaneous choledochoscopy via T tube sinus tract is a common modality for treating retained intrahepatic stones in China. We report a rare complication of postoperative choledochoscopy for treating retained hepatolithiasis: T tube sinus tract duodenal fistula.MethodsFrom January 2003 to December 2018, intrahepatic duct stones with or without common bile duct stones were detected in 1031 patients. Fifteen of the 1031 patients with intrahepatic stones developed a T tube sinus tract duodenal fistula that was diagnosed by cholangiography and choledochoscopy.ResultsThe incidence of T tube sinus tract duodenal fistula in patients with retained intrahepatic stones being treated by postoperative choledochoscopy is 1.45% (15/1031) in this series. The chi-squared test showed that hypoalbuminemia (P = 0.003), long duration of T tube (P = 0.002), and high frequency of procedure (P = 0.008) might be associated with the occurrence of T tube sinus tract duodenal fistula. The logistic regression analysis demonstrated that hypoalbuminemia might be the independent risk factor for this special fistula (P = 0.037).ConclusionsHypoalbuminemia, long time placement of T tube in situ and high frequency of procedure are probably the main causes of the T tube sinus tract duodenal fistula. Placement of T tube in correct way and improving nutritional status may be the key points to prevent the formation of T tube sinus tract duodenal fistula.

Highlights

Hepatolithiasis or intrahepatic duct stones is prevalent in East Asia [1, 2]
Fifteen of the 1031 (1.45%) patients with intrahepatic stones included in this series developed a T tube sinus tract duodenal fistula that was diagnosed by cholangiography and choledochoscopy
The fistulas were not observed during the previous procedure and the T tubes were unintentionally inserted into duodenum through the T tube tract duodenal fistula channel in 9 patients

Summary

Introduction

Hepatolithiasis or intrahepatic duct stones is prevalent in East Asia [1, 2]. Various lithotripsy techniques and liver resection were widely used for treatment of intrahepatic duct stones, the clearance rate of intrahepatic stones has increased in recent years [3, 4]. Postoperative percutaneous choledochoscopy via the T tube sinus tract is a safe and effective approach for treating retained or residual intrahepatic stones [5]. The complications of percutaneous choledochoscopy such as fever (cholangitis), biliary duct bleeding, and T tube inadvertently dislodgement are usually mild and not life threatening.

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