Bacterial contamination of the biliary tree after choledochostomy

Area of Science:

• Gastroenterology
• Surgical Infections
• Biliary Tract Surgery

Background:

• Choledochostomy for common bile duct exploration and T-tube drainage is a common surgical procedure.
• Post-operative biliary tract infection following choledochostomy can lead to significant long-term patient morbidity.
• The frequency of sterile bile converting to infected bile after choledochostomy is not well-documented.

Observation:

• A study reviewed 95 patients undergoing common bile duct exploration and T-tube drainage between 1966 and 1975.
• Intraoperative and postoperative bile cultures were analyzed from 5 to 40 days post-operation.
• Bacterial contamination developed in 44% of previously sterile bile specimens postoperatively.

Findings:

• 42% of patients had bacteria present in the common bile duct during surgery.
• 14% of patients maintained sterile bile throughout the study period.
• Klebsiella group and Escherichia coli were the most frequent secondary contaminants identified.

Implications:

• Persistent biliary infection, even in anatomically normal biliary trees, can lead to complications like pigment calculi formation.
• Foreign bodies, such as T-tubes, can harbor bacteria, making eradication difficult.
• Recommendations include employing closed biliary drainage systems and administering antibiotics for 7-10 days post-T-tube removal to prevent persistent infection.