Cholangiography is the x-ray examination of the bile ducts (biliary tract) after administration of a contrast dye to delineate these channels on the images. The procedure may be performed either during gallbladder removal surgery (operative cholangiography) or postoperatively (T-tube cholangiography).
Operative cholangiography involves injecting the contrast dye directly into the common bile duct during open surgery. X-ray films are then used to guide the surgeon and to identify any stones or other obstructions for immediate removal.
T-tube cholangiography is typically performed 5 to 10 days after gallbladder removal. Contrast dye is injected through a T-shaped rubber tube placed in the common bile duct during surgery, and x-rays are then taken to detect any residual stones or other abnormalities.
Purpose of the T-tube and Operative Cholangiography
- To detect stones or stone fragments and other abnormalities in the bile ducts, such as strictures (narrowings), abnormal growths, and fistulae (abnormal openings)
Who Performs It
- Operative cholangiography is performed by a surgeon, usually accompanied by a radiologist.
- T-tube cholangiography can be performed by an x-ray technician, a nurse, or a doctor.
- Pregnant women should not undergo this test because exposure to ionizing radiation may harm the fetus.
- People with allergies to iodine or shellfish may experience an allergic reaction to the iodine-based contrast dye.
- Severe obesity or the presence of gas overlying the bile ducts may obscure the x-ray findings.
- Residual barium in the abdomen due to a recent contrast x-ray study of the digestive tract may interfere with visualization of the bile duct.
Before the T-tube and Operative Cholangiography
- Inform your doctor if you have an allergy to iodine or shellfish. You may be given a combined antihistamine-steroid preparation to reduce the risk of an allergic reaction to the contrast dye.
- Fasting is usually not required before T-tube cholangiography, but the standard preoperative restrictions on food and drink apply before operative cholangiography.
- You will be asked to disrobe and put on a hospital gown.
What You Experience
- During gallbladder removal surgery, a catheter or thin needle is inserted into a bile duct and contrast dye is infused directly into the biliary tract.
- X-ray films are obtained during the operation and immediately reviewed by the surgeon.
- If stones or other obstructions are detected on x-rays, they are removed by the surgeon before the incision is closed.
- After gallbladder removal surgery, a T-tube is left in place to facilitate drainage. Cholangiography typically occurs 5 to 10 days later.
- You will lie on your back on an x-ray table. An antiseptic solution is used to cleanse the T-tube.
- The contrast dye is injected into the T-tube. You may feel a bloating sensation in the upper right abdomen as it is injected.
- X-rays and fluoroscopy are used to visualize the biliary tract. You are instructed to assume various positions as x-ray films are obtained.
- The procedure takes about 15 minutes.
Risks and Complications
- Both tests involve exposure to low levels of ionizing radiation.
- Some people may experience an allergic reaction to the iodine-based contrast dye, which can cause symptoms such as nausea, sneezing, vomiting, hives, and occasionally a life-threatening response called anaphylactic shock. Emergency medications and equipment are kept readily available.
- In extremely rare cases, blood infection (sepsis) may occur.
After the T-tube and Operative Cholangiography
- If the T-tube is left in place, a sterile, closed drainage system is attached to it.
- If the tube is removed, a nurse applies a sterile dressing and records any drainage. The dressing is changed as necessary.
- You may gradually resume your normal activities.
- The doctor examines the x-ray images for evidence of any bile duct abnormality.
- If bile duct stones or other abnormalities are detected with operative cholangiography, the surgeon can correct the problem before closing the incision.
- If residual stones are detected with T-tube cholangiography, they can be extracted through the tube tract. If no abnormalities are detected, the tube is removed.
- In some cases, additional tests may be needed to further evaluate abnormal results.
The Johns Hopkins Consumer Guide to Medical Tests
Simeon Margolis, M.D., Ph.D., Medical Editor
Updated by Remedy Health Media