Choledochus angulation by T-tube

The presence of bile stasis is a frequent mechanism for presenting choledocholithiasis and recurrence of this one. The bile duct angulation, also known as "elbow sign," could be a risk factor for reducing the flow of bile and forming stones and it has been reported as a consequence secondary to the use of T-tube. The recurrence of choledocholithiasis without the use of T-tube in the bile duct is minimal, whereas in those with T-tube is four times higher in bile duct exploration surgeries. We present a case report of a patient who underwent T-tube laparoscopic bile duct exploration surgery, who had a bile duct angulation and residual choledocholithiasis as a complication.

34-yeard-old female, who presented acute cholecystitis and underwent cholecystectomy. In this operation it was detected choledocholithiasis, which is why it was carried out a T-tube bile duct exploration surgery for acute cholecystitis, without solving the choledocholithiasis condition. Afterwards, she had three endoscopic retrograde cholangiopancreatography procedures, requiring endoscopic hemoclip. Four months later, she was referred to a third-level hospital for definitive treatment with unsolved choledocholithiasis.

The bile duct angulation by T-tube is unusual and it favors bile duct dilatation, stasis of bile pigments and new stones formation. We consider that the best surgical option is the biliary bypass.