title: Bile leakage following T-tube removal in orthotopic liver transplantation.
abstract: OBJECTIVE
  Biliary tract complications constitute a common cause of post-operative morbidity after orthotopic liver transplantation. Bile leakage following T-tube removal, even if uncommon, can also seriously influence post-operative recovery. This report outlines the diagnostic and therapeutic policy used to treat this complication in a large liver transplantation center.
  
  
  METHODS
  Fourteen consecutive cases of bile leakage after T-tube removal are presented. Abdominal pain was the most common symptom and acute abdomen developed in one third of the patients. Ultrasonography was the most common imaging technique used.
  
  
  RESULTS
  Five patients were treated conservatively with or without percutaneous drainage of the biloma and 9 patients underwent an exploratory laparotomy. Ligation of the T-tube tract was the most common technique used. All patients 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 fibrous T-tube tract formation due to immunosuppression or the underlying disease could be an explanation for the development of this complication.
authors.affiliation: Transplant Institute, University of Pittsburgh School of Medicine, Pennsylvania, USA.
authors.forename: K
authors.initials: K
authors.lastname: Tepetes
authors.forename: D
authors.initials: D
authors.lastname: Karavias
authors.forename: E
authors.initials: E
authors.lastname: Felekouras
authors.forename: N
authors.initials: N
authors.lastname: Jabour
authors.forename: A
authors.initials: A
authors.lastname: Tzakis
authors.forename: E
authors.initials: E
authors.lastname: Starzl
mesh_terms: D001646:Bile; D001660:Biliary Tract Diseases / Q000175:diagnosis / Q000209:etiology*; D004322:Drainage / Q000295:instrumentation*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*