Case 6: Bile in the drain tube
10 days after a laparotomy for a perforated gastric antral ulcer, there was bile draining from the drain tube.
1. What xray has been performed?.
A fluoroscopic sinogram (contrast injected down the drain tube).2. What does it show?
The film shows contrast flowing down the drain tube and filling a cavity around the second (descending part) of the duodenum. The contrast is also seen entering the duodenal lumen. (on the film seen just to the medial aspect of the cavity)With a perforated gastric antral ulcer the options are to patch repair the defect with an omental patch (also taking an ulcer edge biopsy to exclude malignancy). However, with a larger ulcer a distal gastrectomy may be required (as in this case) with the consequent risk of duodenal stump leakage.