A 43-year-old woman undergoes open cholecystectomy. Intraoperative cholangiogram revealed multiple stones in the CBD. Exploration of the CBD was performed to extract gallstones. The CBD was drained with a T-tube. After 10 days, a T-tube cholangiogram reveals a retained CBD stone. This should be treated by which of the following?
Laparotomy and CBD exploration
Subcutaneous heparinization
Antibiotic therapy for 6 months and then reevaluation
Extraction of the stone through the pathway created by the T-tube (after 6 weeks)
If a stone is detected, the T tube should be left in place for 6 weeks to allow the tract to mature. At this time, the T tube can be removed, and the stone can be extracted by using a Dormia basket under fluoroscopy. This approach is indicated only when a T-tube larger than 16 has been inserted. If this approach is not feasible, the stone can be extracted by retrograde endoscopic techniques or CBD exploration.
Pancreas