Drainage of bile ducts with an articulated T tube.

An articulated T tube has been devised to simplify percutaneous replacement. Because the crosspiece and the stem are held together with sutures, they can be aligned over a catheter and guide wire for atraumatic insertion into the bile duct. By pulling the suture taut, the articulated T tube is easily reconstituted. A second suture can be attached to the proximal limb of the crosspiece to extract it end-on at a latter date without enlarging the tract. This articulated tube has been found very useful for safely replacing T tubes that have fallen out of immature tracts (n = 2) and inserting T tubes in tumor-encased bile ducts either via an existing T-tube tract (n = 1) or transhepatically (n = 1). This design extends the usefulness of T tubes for efficient intra- or extrahepatic bile duct drainage.