Bile leakage following T-tube removal in orthotopic liver transplantation

BACKGROUND/AIMS: Biliary tract complications constitute a common cause of p ost-operative morbidity after orthotopic liver transplantation. Bile leakag e following T-tube removal, even if uncommon, can also seriously influence post-operative recovery. This report outlines the diagnostic and therapeuti c policy used to treat this complication in a large liver transplantation c enter. METHODOLOGY: Fourteen consecutive cases of bile leakage after T-tube remova l are presented. Abdominal pain was the most common symptom and acute abdom en developed in one third of the patients. Ultrasonography was the most com mon imaging technique used. RESULTS: Five patients were treated conservatively with or without percutan eous drainage of the biloma and 9 patients underwent an exploratory laparot omy. Ligation of the T-tube tract was the most common technique used. All p atients had an uneventful clinical course. CONCLUSIONS: Clinical signs are the most important factor in the diagnosis of this complication, and should be treated surgically if the patient does not improve within 24-48 hours under conservative management. Inadequate fi brous T-tube tract formation due to immunosuppression or the underlying dis ease could be an explanation for the development of this complication.