From the Guidelines
Pain after biliary drain removal is most commonly caused by inflammation of the liver capsule and surrounding tissues as they close the tract left by the tube, and typically resolves within a few days. The provided evidence 1 focuses on the management and detection of bile duct injuries during cholecystectomy, but does not directly address the cause of pain after biliary drain removal. However, based on general medical knowledge, the pain is likely due to the irritation of the tissue layers during the healing process.
Some key points to consider when managing pain after biliary drain removal include:
- Taking acetaminophen (Tylenol) 650-1000 mg every 6 hours as needed, not exceeding 4000 mg daily, for mild to moderate pain
- Using NSAIDs like ibuprofen 400-600 mg every 6-8 hours with food, or a short course of opioid medication such as hydrocodone/acetaminophen 5/325 mg every 4-6 hours for 2-3 days, for more severe pain
- Applying a clean, dry dressing to the removal site and changing it daily until the site closes, usually within 24-48 hours
- Watching for signs of infection, including increasing pain, redness, swelling, fever above 101°F, or drainage with foul odor
It is essential to note that if pain worsens after 48-72 hours or if fever, jaundice, or dark urine develop, patients should contact their healthcare provider immediately, as these could indicate complications like bile leakage or infection 1. The management of bile duct injuries and related complications is crucial to prevent long-term sequelae, such as secondary biliary cirrhosis, liver failure, and death 1.
From the Research
Causes of Biliary Drain Pain
- Bile leaks following T-tube removal can cause abdominal pain, as diagnosed by ultrasound examination 2
- Biliary tract complications, such as bile ascites, biloma, or bile peritonitis, can occur after T-tube removal 3
- T-tube removal can result in biliary leakage and bacteraemia, which can cause pain and other complications 4
- Technical factors, such as inappropriate suturing of the drain to the ductal wall, can contribute to bile leakage and subsequent pain 5
- Patient-related factors, such as corticotherapy, chemotherapy, and ascites, can also increase the risk of bile leakage and pain 5
Management of Biliary Drain Pain
- Endoscopic placement of endobiliary prosthesis and percutaneous biliary drainage can be used as first-line therapy for significant fistula after T-tube removal 2
- Fluoroscopic removal of T-tubes can help visualize the T-tube tract and prevent complications of tract disruption and subsequent bile leak 3
- Broad spectrum antibiotic cover can be employed at the time of T-tube removal to reduce the risk of complications 4
- Conservative therapy, including percutaneous drainage and endoscopic placement of a trans-ampullary biliary drainage, can be used for well-tolerated bile leakage 5