The mechanism of T tube dislocation and its prevention

Dislodgement of the T tube from the common bile duct is an uncommon but potentially serious or even lethal complication. Partial dislodgment with one limb of the T tube lying outside the duct is more common than complete dislocation into the peritoneal cavity. The mechanism for this accident is not always clear; often the patient is blamed for apparently pulling on the tube, even though it is securely sutured to the skin. An alternative hypothesis is presented-namely, that a postoperative adynamic ileus can displace the tube by stretching one of the points of fixation. This has been proved by distending an experimental animal's abdomen by inducing a pneumoperitoneum or by distending the gastrointestinal tract by air insufflation. Dislodgment of the T tube is rendered more likely when the tube is brought through the abdominal wall without slack, as opposed to use of a gentle intra-abdominal loop. The former technique being encouraged by persons engaged in the removal of retained calculi through the T tube track. Further suggestions are made that might reduce the incidence of partial or complete T tube dislodgment.