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.

Special Concerns

  • 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

Operative cholangiography:

  • 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.

T-tube cholangiography:

  • 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.

Results

  • 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.

Source:

The Johns Hopkins Consumer Guide to Medical Tests

Simeon Margolis, M.D., Ph.D., Medical Editor

Updated by Remedy Health Media

Publication Review By: the Editorial Staff at Healthcommunities.com

Published: 24 Jan 2012

Last Modified: 11 Sep 2015