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To the Editor:—
I would like to comment on the question and answer to the letter regarding excessive t-tube drainage following cholecystectomy (208:541, 1969).The most common cause of t-tube drainage in excess of 1,000 cc/24 hr is reflux of pancreatic or duodenal secretions into the common duct. I have seen this commonly in patients with a "short" arm t-tube that does not enter the duodenum. Obviously, one may have a "tight" sphincter of Oddi with a common channel of bile and pancreatic juice or patulous sphincter with duodenal contents refluxing up the common duct.The diagnosis is easily confirmed by testing the "bile" for the presence of amylase.
Freeark RJ. Excessive T-Tube Drainage Following Cholecystectomy. JAMA. 1969;209(2):269. doi:10.1001/jama.1969.03160150055024