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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.