Perforation Of Bile Duct Research Articles

同期三镜、扩张导管、气囊鼻胆管治疗肝左外叶及胆总管结石26例

目的：探讨同期三镜(腹腔镜、胆管镜、十二指肠镜)、扩张导管(逐级扩张导管、球囊导管)、气囊鼻胆管(LCDND)治疗肝左外叶及胆总管结石的应用体会。方法：回顾性分析成都市第二人民医院2011年3月至2017年9月期间，符合入选标准的26例患者的临床资料。结果：腹腔镜下切除肝左外叶和探查胆总管胆管镜取石26例，切除胆囊15例。逐级导管扩张左肝管和乳头并留置气囊鼻胆管65.5% (17/26)，逐级导管扩张左肝管和推挤左肝管结石出总管切口并留置气囊鼻胆管11.5% (3/26)，逐级导管联合球囊导管扩张左肝管并留置气囊鼻胆管3.8% (1/26)，逐级导管扩张左肝管和乳头、十二指肠镜行乳头小切开或微切开并留置气囊鼻胆管11.5% (3/26)，逐级导管扩张左肝管后因肝内胆管残石并腹腔镜下留置T管7.7% (2/26)。鼻胆管引流术后无残石，胆汁漏2例(7.7%)，轻症胰腺炎1例(3.8%)。无肠穿孔、胆管穿孔、大出血、重症胰腺炎等并发症，无围手术期再次手术和死亡患者。术后总并发症发生率为11.5% (3/26)。结论：从本研究对本医院有限病例进行初步研究发现，只要病例选择合适，LCDND治疗肝左外叶及胆总管结石是可行、有效和安全的。 Objective: To explore the surgical technique and clinical effect of laparoscopy, choledochoscopy, duodenoscopy, dilatable catheter and balloon nasobiliary drainage (LCDND) of the corresponding period for the treatment of the left lateral lobe hepatic duct and common bile duct stones during the course of therapeutic laparoscopy. Methods: The clinical data of 26 cases of the left lateral lobe hepatic duct and common bile duct stones undergoing LCDND were analyzed retrospectively from March 2011 to September 2017 in the Second People’s Hospital of Chengdu. Results: It was in 26 cases removed the left hepatic lateral lobe and exploration of common bile duct and in 15 cases removed the gallbladder by laparoscopy. Through the duct incision with choledochoscopy to remove gallstones, step by step dilatable catheter expanded left hepatic duct and duodenal papilla and indwelling balloon nasobiliary was in 65.5% (17/26); push the stones into the common hepatic duct in 11.5% (3/26); step by step dilatable catheter combining balloon catheter expanded left hepatic duct and duodenal papilla and indwelling balloon nasobiliary was in and 3.8% (1/26); step by step dilatable catheter expanded left hepatic duct and duodenal papilla and duodenoscopic papillary sphincterotomy of micro incision or small incision, and indwelling balloon nasobiliary was in 11.5% (3/26); via choledochoscopic examination indwelling T shape tube drainage due to residual stone of the intrahepatic bile duct in 7.7% (2/26). Residual stone was not occurred after the nasobiliary drainage. Bile leakage was cured in two cases (7.7%). One patient (3.8%) was a slight pancreatitis. No cases had perforation of intestine and bile duct, bleeding, severe pancreatitis. No perioperative reoperation and death. Total postoperative complication formation rate was in 11.5% (3/26). Conclusion: From preliminary results of limited cases in this study in our hospital, if patients are suitable, LCDND for treatment of the left lateral lobe hepatic duct stones and common bile duct stones, it is safe and effective.

Ascitic Fluid/Serum Bilirubin Ratio as an aid in Preoperative Diagnosis of Choleperitoneum in a Neglected Case of Spontaneous Common Bile Duct Perforation.

Spontaneous perforation of extrahepatic biliary system is a rare and potentially fatal cause of acute abdomen. Clinical presentation is as biliary peritonitis. This condition is rarely suspected as a cause of peritonitis preoperatively and correct diagnosis is made during surgery. If suspected, diagnosis can be made by various imaging techniques like hepatobiliary scintigraphy, magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde cholangiopancreatography (ERCP). As these imaging techniques are not readily available, especially in low socioeconomic countries, we hereby report a case of spontaneous common bile duct (CBD) perforation, which was diagnosed preoperatively by estimation of ascitic fluid-to-serum bilirubin ratio, a simple, quick, and cost-effective test.How to cite this article: Huda F, Naithani M, Singh SK, Saha S. Ascitic Fluid/Serum Bilirubin Ratio as an aid in Preoperative Diagnosis of Choleperitoneum in a Neglected Case of Spontaneous Common Bile Duct Perforation. Euroasian J Hepato-Gastroenterol 2017;7(2):185-187.

Spontaneous Common Bile Duct Perforation Treated with Placement of Metal Stent

총담관의 ìžë°œì  천공은 흔하지 않으며, 이에 대해 충분한 연구와 경험이 부족한 상태이다. 본 ì €ìžë“¤ì€ 원인을 알 수 없는 복통과 난치성 복수를 호소하는 환자에서 총담관의 ìžë°œì  천공을 ì§„ë‹¨í•˜ê³ , ë‚´ì‹œê²½ì—­í–‰ë‹´ì·Œê´€ì¡°ì˜ìˆ ì„ 통한 ì™„ì „í”¼ë§‰í˜• 자가팽창형 ê¸ˆì†ìŠ¤í íŠ¸ì˜ ì‚½ìž ìˆ ê³¼ ë³´ì¡´ì  치료를 통하여 치료에 성공했던 증례를 경험하였기에 ë³´ê³ í•œë‹¤. Keywords: ìžë°œì  담즙 누출, 총담관 결석, ë‚´ì‹œê²½ì  역행성담도 ì·Œê´€ì¡°ì˜ìˆ , 담관 천공, 복수

Recent Advanced Endoscopic Management of Endoscopic Retrograde Cholangiopancreatography Related Duodenal Perforations.

The management strategy for endoscopic retrograde cholangiopancreatography-related duodenal perforation can be determined based on the site and extent of injury, the patient’s condition, and time to diagnosis. Most cases of perivaterian or bile duct perforation can be managed with a biliary stent or nasobiliary drainage. Duodenal wall perforations had been treated with immediate surgical repair. However, with the development of endoscopic devices and techniques, endoscopic closure has been reported to be a safe and effective treatment that uses through-the-scope clips, ligation band, fibrin glue, endoclips and endoloops, an over-the-scope clipping device, suturing devices, covering luminal stents, and open-pore film drainage. Endoscopic therapy could be instituted in selected patients in whom perforation was identified early or during the procedure. Early diagnosis, proper conservative management, and effective endoscopic closure are required for favorable outcomes of non-surgical management. If endoscopic treatment fails, or in the cases of clinical deterioration, prompt surgical management should be considered.

Diagnosis and treatment of spontaneous perforation of the bile duct in children

目的 探讨小儿自发性胆道穿孔(包括胆总管囊肿合并穿孔及特发性胆道穿孔)的病因、诊断及治疗。 方法 分析我院2008年1月至2013年1月收治的12例小儿胆道穿孔患儿的临床资料。 结果 12例患儿经手术治疗均治愈，随访至少1年，无近期并发症。 结论 胰胆管合流异常可能是胆总管囊肿合并穿孔的主要原因，局部胚胎发育异常，胆总管壁薄弱及感染可能是引起特发性胆道穿孔的原因。腹部超声及腹腔穿刺对本病的诊断有重要价值。胆道穿孔均需通过手术治疗，但胆总管囊肿合并穿孔与特发性胆道穿孔手术方式却有差异。

Percutaneous intraductal radiofrequency ablation in the management of unresectable Bismuth types III and IV hilar cholangiocarcinoma

PurposeTo assess the feasibility and safety of percutaneous intraductal radiofrequency ablation (RFA) for unresectable Bismuth types III and IV hilar cholangiocarcinoma.ResultsPercutaneous intraductal RFA combined with metal stent placement was successful in all patients without any technical problems; the technical success rate was 100%. Chemotherapy was administered to two patients. After treatment, serum direct bilirubin levels were notably decreased. Six patients died during the follow-up period. Median stent patency from the time of the first RFA and survival from the time of diagnosis were 100 days (95% confidence interval (CI), 85–115 days) and 5.3 months (95% CI, 2.5–8.1 months), respectively. No acute pancreatitis, bile duct bleeding and perforation, bile leakage, or other severe complications occurred. Four cases of procedure-related cholangitis, three cases of postoperative abdominal pain, and five cases of asymptomatic transient increase in serum amylase were observed. One patient who presented with stent blockage 252 days' post-procedure underwent repeat ablation.Materials and MethodsBetween September 2013 and May 2015, nine patients with unresectable Bismuth types III and IV hilar cholangiocarcinoma who were treated with percutaneous intraductal RFA combined with metal stent placement after the percutaneous transhepatic cholangial drainage were included in the retrospective analysis. Procedure-related complications, stent patency, and survival after treatment were investigated.ConclusionPercutaneous intraductal RFA combined with metal stent placement is a technically safe and feasible therapeutic option for the palliative treatment of unresectable Bismuth types III and IV hilar cholangiocarcinoma. Its long-term efficacy and safety is promising, but needs further study via randomized and prospective trials that include a greater number of patients.

An Unexpected Complication in a Pediatric Patient With Sclerosing Cholangitis: A Huge Spontaneous Biloma

Introduction: Biloma is encapsulated collection of bile due to iatrogenic injury or abdominal trauma. The perforation of the extra-intrahepatic bile duct without any traumatic or iatrogenic injury is defined as spontaneous biloma. The spontaneous biloma is very rare and infrequently reachesto huge sizes. Previously described causes of spontaneous biloma include choledocholithiasis, acute cholecystitis, cholangiocarcinoma, pancreatic malignancy and hepatic abscesses or infarctions. Case Presentation: We describe the case of a huge spontaneous biloma in a 16-year-old girl patient with sclerosing cholangitis. She applied to our hospital for generalised abdominal distention and pain. There was no cholestasis at her admission, but, interestingly cholestasis developed on the tenth day of hospitalization.She was treated with percutaneous drainage, endoscopic sphincterotomy and stent placement into the common bile duct. After discharge, there was no recurrence at the three-month follow-up. Conclusions: To our knowledge, this is the first report in the literature of spontaneous biloma associated with sclerosing cholangitis.

Clinical effect of laparoscopic reverse papillary intubation through cystic duct to treat cholecystolithiasis and thining choledocholithiasis

Objective To investigate the clinical effect of laparoscopic reverse papillary intubation through cystic duct and laparoscope combined with duodenoscope in the treatment of cholecystolithiasis and thining choledocholithiasis. Methods The retrospective cohort study was adopted. The clinical data of 192 patients with cholecystolithiasis and thining choledocholithiasis who were admitted to Chengdu Second People's Hospital between May 2012 to August 2015 were collected. The 96 patients who underwent laparoscopic reverse papillary intubation through cystic duct were allocated into the case group, and the other 96 who received surgery by laparoscope combined with duodenoscope were allocated into the control group. All the patients underwent laparoscopic cholecystectomy (LC) according to routine approaches. The 96 patients in the case group received the placement of 4 Fr ureter catheter via cystic duct and placement of common bile duct inserted through the duodenal papilla under laparoscope, and then the duodenal papilla was resected using needle knife along the ureter catheter and stones were removed by basket lithotriptor and ball lithotriptor. The 96 patients in the control group received the intubation using the bow knife with zebra guidewire, and stones were removed by basket lithotriptor and ball lithotriptor. During the operations, it was observed whether there were residual stones by nasobiliary radiograph. The comparison was made between the 2 groups concerning (1) surgical situation: intubation and operation time. (2) Postoperative alanine transaminase (ALT), postoperative aspartate transaminase (AST), postoperative total bilirubin (TBil), postoperative blood amylase, postoperative lipase, complications and extubation time. (3) Situation of follow-up: follow-up was done by outpatient examination or telephone interview up to November 2015. The stones recurrence was detected by retrograde cholangiography through nasal bile duct, magnetic resonance cholangiopancreatography (MRCP) or ultrasonic examination. Measurement data with normal distribution were represented as ±s. Comparison between groups was done by the t test. Count data were analyzed by the chi-square test. Results (1) Surgical situation: 2 groups both underwent successful LC. Ureteral catheter in the case group was successfully imbedded through cystic duct, including 8 patients with being difficult to intubate. Five patients in the control group were failed in endoscopic sphincterotomy (EST) due to periamullary diverticula or other causes, and then EST was performed again by the duodenal papilla through ureteral catheter which was intubated through cystic duct. Operation time of the case group and control group was (89±17)minutes and (105±26)minutes, respectively, with a statistically significant difference between the 2 groups (t=5.05, P 0.05). Postoperative blood amylase and lipase of the case group and control group were (151±41)U/L, (198±72)U/L and (395±142)U/L, (549±217)U/L, respectively, showing statistically significant differences (t=16.18, 15.05, P<0.05). No pancreatitis was found in the case group while 6 patients in the control group complicated with mild pancreatitis were improved by symptomatic treatment of fasting, somatostatin administration and acid suppression, with no severe pancreatitis. No complications such as intestinal perforation, bile duct perforation and massive hemorrhage were detected in both groups after operation. No death occurred. The nasal bile duct in the patients without pancreatitis was removed at postoperative day 3. The nasal bile duct in the patients with pancreatitis was removed after the remission of abdominal pain and diet intake. In the case group, it was difficult to remove the nasal bile duct of 1 patient. Nasal bile duct radiograph showed that the bending section of nasal bile duct was mistakenly sutured by the absorbable thread at the lower margin of incision of junction of cystic ducts, and yet there was unobstructed biliary drainage. The nasal bile duct was removed and the patient was discharged from hospital at postoperative day 19. The abdominal drainage tubes were removed at postoperative day 3 to 5 in both groups. (3) Of 192 patients, 151 were followed up for a median time of 10 months (range, 3-12 months). Patients had good recovery without recurrence of abdominal pain, jaundice and stones. Conclusion Laparoscopic reverse papillary intubation through cystic duct for the treatment of cholecystolithiasis and thining choledocholithiasis is safe and feasible, and it can also reduce incidence of pancreatitis after nasobiliary drainage. Key words: Cholelithiasis; Choledocholithiasis; Laparoscopy; Endoscopy; Nasobiliary drainage

Endoscopic palliation of unresectable periampullary tumors

Aims: Distal malignant biliary obstruction may be caused by various neoplasms, such as pancreatic cancer, ampullary tumors and cholangio-carcinoma. The endoscopic approach is more cost-effective than the operative approach. The use of plastic stents is nowadays recommended in patients with poor prognosis (less than 5–6 months). Initial endoscopic placement of a metal stent is a cost-saving strategy only in patients expected to survive longer than six months. Methods: Over a 6 - year period, from 2009 to 2014, a total of 458 endoscopic transpapillary interventions were analyzed. Results: 235 patients (51,3%) were treated for pancreatic head tumor, 122 patients (26,6%) - for papilla of Vater tumor, and 101 (22,1%) - due to distal cholangiocarcinoma. 32 patients (7.0%) had endoscopic treatment failure.Plastic prostheses were inserted in 218 (51.2%) patients, self-expanding metal prostheses - in 96 patients (22.5%), suprapapillary choledochoduodenostomy - in 112 (26,3%) cases. 38 (9%) patients had following complications of endoscopic treatment: bleeding into the digestive tract - 15 cases (3,5%), acute pancreatitis -6 cases (1,4%), bile duct perforation - 1 case (0,2%), stent migration - 7 (1.6%), early stent obstruction - 10 (2.3%) cases. All cases of pancreatitis were treated successfully with conservative therapy. 13 cases of bleeding stopped after endoscopic hemostasis, 2 - after endovascular embolization. In cases of early clogging of the prostheses and stent migration we performed an urgent stent replacement. The 30-day mortality rate was 0.7%, as a result of fatal septic conditions in three patients. Stent occlusion occurred after a mean of 285 days for the metal stent group vs 82 days for the plastic stent group. Conclusions: Endoscopic stent insertion is the modality of choice. It provides effective palliation and may offer lower morbidity and mortality, shorter hospital stay, and diminished overall cost compared with surgical or radiological approaches.

Delayed Severe Hemobilia after Endoscopic Biliary Plastic Stent Insertion.

Hemobilia is a rare gastrointestinal bleeding, usually caused by injury to the bile duct. Hemobilia after endoscopic retrograde cholangiopancreatography (ERCP) is generally self-limiting and patients will spontaneously recover, but some severe and fatal hemorrhages have been reported. ERCP-related bowel or bile duct perforation should be managed promptly, according to the type of injury and the status of the patient. We recently experienced a case of late-onset severe hemobilia in which the patient recovered after endoscopic biliary stent insertion. The problem was attributable to ERCP-related bile duct perforation during stone removal, approximately 5 weeks prior to the hemorrhagic episode. The removal of the stent was performed 10 days before the onset of hemobilia. The bleeding was successfully treated by two sessions of transarterial coil embolization.

Spontaneous Perforation of Common Bile Duct: A Rare Presentation of Gall Stones Disease.

Background. Spontaneous perforation of the extrahepatic biliary system is a rare presentation of gall stones. Very few cases of bile duct perforation have been reported in adults. It is rarely suspected or correctly diagnosed preoperatively. Case Presentation. A 66-year-old female presented at the surgical emergency with 3 days' history of severe upper abdominal pain with distension and repeated episodes of vomiting, as she had evidence of generalized peritonitis and underwent an exploratory laparotomy. A single 0.5 cm × 0.5 cm free perforation was present on the anterolateral surface of the common bile duct at the junction of cystic duct. A cholecystectomy and the CBD exploration were performed. Conclusion. Spontaneous perforation of the extrahepatic bile duct is a rare but important presentation of gall stones in adults. Therefore, awareness of the clinical presentation, expert ultrasound examination, and surgery are important aspects in the management.

Spontaneous common bile duct perforation in an adult female patient presenting with severe epigastric pain mimicking acute pancreatitis

Spontaneous common bile duct (CBD) perforation is a rare event, and mostly occurs in infants with CBD stones and rarely occurs in adults. A 19-year-old female patient presented to us with severe acute epigastric pain mimicking acute pancreatitis, together with vomiting, abdominal distention, and tenderness. Abdominal radiograph and upper gastrointestinal tract endoscopy were normal. Abdominal ultrasound and computed tomography showed retroperitoneal collection near the pancreas. Diagnostic aspiration showed greenish yellow turbid aspirate with very high bilirubin in ascitic fluid than in serum. The case complicated with biliary peritonitis. Laparotomy was performed, and revealed posterior CBD perforation. Peritoneal washing was carried out with removal of about 6 l of bile. Cholecystectomy with CBD exploration was performed, and the CBD was closed over a T-tube and external drainage was carried out. The patient stayed in hospital for 17 days postoperatively and was discharged after removal of the T-tube and drain. She came for follow-up after 1 month from discharge in a very good general condition.

Spontaneous Perforation of Common Bile Duct: Abscess Formation Presenting as a Choledochal Cyst

Spontaneous Perforation of Common Bile Duct: Abscess Formation Presenting as a Choledochal Cyst

Development of a Swine Benign Biliary Stricture Model Using Endoscopic Biliary Radiofrequency Ablation.

The large animal model with benign biliary stricture (BBS) is essential to undergo experiment on developing new devices and endoscopic treatment. This study conducted to establish a clinically relevant porcine BBS model by means of endobiliary radiofrequency ablation (RFA). Endoscopic retrograde cholangiography (ERC) was performed on 12 swine. The animals were allocated to three groups (60, 80, and 100 W) according to the electrical power level of RFA electrode. Endobiliary RFA was applied to the common bile duct for 60 seconds using an RFA catheter that was endoscopically inserted. ERC was repeated two and four weeks, respectively, after the RFA to identify BBS. After the strictures were identified, histologic evaluations were performed. On the follow-up ERC two weeks after the procedure, a segmental bile duct stricture was observed in all animals. On microscopic examination, severe periductal fibrosis and luminal obliteration with transmural inflammation were demonstrated. Bile duct perforations occurred in two pigs (100 W, n = 1; 80 W, n = 1) but there were no major complications in the 60 W group. The application of endobiliary RFA with 60 W electrical power resulted in a safe and reproducible swine model of BBS.

A Case of Suspected Intrahepatic Bile Duct Perforation after Direct Peroral Cholangioscopy

내시경 기술의 발전과 함께 경구 담도내시경(peroral cholangioscopy, POC)이 도입되면서 내시경을 직접 담도에 삽입 하여 관찰하거나 담도 질환의 치료 목적으로 사용할 수 있게 되었다. 고전적으로 사용되었던 모자 담도내시경(motherbaby duodenoscope)은 수기가 비교적 복잡하고 숙련된 두 명의 내시경의사가 필요하다는 단점이 있어 최근 한 명의 내 시경의사가 검사를 할 수 있는 POC가 개발되었는데, 그 중 하나가 극세경상부위장관내시경(ultra-slim upper endoscope)을 이용한 내시경 방법이다. 이 방법은 극세경상부위 장관내시경을 확장된 유두부 입구를 통하여 총담관으로 삽 입한 후 담관을 직접 관찰하는 방법으로 direct POC라고 한 다. 이는 확진이 어려운 담도 내의 병변을 직접 관찰하고 조 직 검사를 시행함으로써 담도 병변의 진단에 유용할 뿐 아니 라 전기수압쇄석장치 등을 이용하여 담석의 치료 목적으로 도 이용되고 있다. 그러나 아직 임상적인 경험이 오래되지 않아 시술의 유용성과 합병증에 대한 보고들이 많지 않은 실 정이다. POC로 인해 발생할 수 있는 합병증은 출혈이나 공 기 색전증, 췌장염 등이 보고되고 있지만 천공은 매우 드문 A Case of Suspected Intrahepatic Bile Duct Perforation after Direct Peroral Cholangioscopy

Spontaneous bile duct perforation with cystic fibrosis and meconium ileus

Abstract Spontaneous bile duct perforation in the newborn is rare, with less than 150 cases reported. A term male newborn presented with abdominal distention and respiratory distress on the first day of life. Paracentesis revealed 420 mL of bile without succus or meconium, and laparoscopic washout and drainage was performed. A follow-up contrast enema several days later revealed a microcolon. The second operation confirmed the spontaneous bile duct perforation, but also revealed meconium ileus with ileal perforation and thick meconium. A sweat chloride study was abnormal and the patient was homozygous for the delta-F508 mutation. This is the first reported case of spontaneous bile duct perforation in association with meconium ileus or cystic fibrosis.

Clinical analysis of the bile duct perforation in children

Objective To explore the etiology, clinical characteristics, diagnosis and treatment of the bile duct perforation in children. Methods The clinical data of 7 children with the bile duct perforation were retrospectively summarized in Wuhan Children's Hospital from April of 2009 to April of 2014. Results There were 7 cases of the children with perforation of the bile duct, 1 male and 6 female, the average age was 2.05 years.The most common pre-senting symptoms were abdominal distension in 7 cases(100.0%), nausea and vomiting in 6 cases(85.7%), abdominal pain in 5 cases(71.4%), jaundice in 1 case(14.3%) and diarrhea in 1 case(14.3%). Six cases experienced preoperative abdominal paracentesis, which all gained bilious ascites.Both abdominal ultrasound and computed tomography(CT) showed ascites in 5 cases.On exploration, sites of perforation were seen in 3 cases(42.8%) at the junction of the common hepatic duct and cystic duct, 1 case(14.3%) at common hepatic duct, and 1 case(14.3%) at common bile duct, while sites of perforation in other 2 cases(28.6%) were not localized.In the cases(case 1, 2, 5 and 7) whose site of perforation was large, the T-tube drainage and peritoneal drainage through laparotomy or laparoscopic surgery was performed.In case 4 whose site of perforation was very small, and case 3 and 6 whose site of perforation was not localized, the cholysystostomy and peritoneal drainage was performed through laparotomy or laparoscopic surgery.Simple closure of the perforation was performed in case 4.Case 4 and 5 showed recurrent abdominal pain after operation and abdominal CT revealed biliary tract dilatation, and then biliary reconstruction was performed.Both of the patients recovered well postoperatively.The other 5 children recovered well and had an uneventful postoperative period from the 7 months to 5 years follow-up. Conclusions Early diagnosis of perforation of the bile duct can be made based on clinical manifestations, abdominal ultrasound and CT and abdominal paracentesis.Active surgical treatment should be performed once diagnosis was made.Depending on the size of perforation of the bile duct, appropriate surgical drainage scheme is made.The children with recurrent abdominal pain and biliary tract dilatation should receive biliary reconstruction. Key words: Biliary tract; Perforation; Choledochocyst

Spontaneous bile duct perforation in an infant, managed with simple drainage

Spontaneous bile duct perforation is a very rare but important cause of surgical jaundice in pediatric patients and one of the most common causes of surgical jaundice during infancy after biliary atresia. Preoperative diagnosis may not be possible in most of the cases. The exact cause of the perforation remains unclear. The diagnosis is usually made at the time of laparotomy. We report a case of spontaneous bile duct perforation in an infant and showed the successful minimal surgical intervention with T-tube insertion as the sole management.Keywords: biliary ascites, biliary peritonitis, spontaneous bile duct perforation, spontaneous biliary perforation

Spontaneous perforation of the common bile duct in chronic renal failure with hemodialysis: a case report

Spontaneous perforation of the common bile duct in chronic renal failure with hemodialysis: a case report

Intact Choledochal Cyst With Spontaneous Common Hepatic Duct Perforation

A 3-month-old girl admitted for lower respiratory infection developed constipation and abdominal distension 3 days later. On examination, she had mild abdominal distension with absent bowel sounds. Abdominal sonography showed a normal biliary tract and pancreas. Computed tomography of abdomen revealed minimal localized fluid collection in the right upper quadrant. Abdominal paracentesis done 24 hours later revealed bile-stained ascitic fluid. Exploratory laparotomy on the same day revealed intact cystic dilation of common bile duct (type 1). Operative cholangiography revealed leakage of contrast from the distal common hepatic duct with a 4-mm perforation that was sutured securely (Fig. 1). Complete excision of the cyst, cholecystectomy, Roux-en-Y hepatojejunostomy, and jejunojejunostomy were performed (Fig. 2).FIGURE 1: Sutured perforation site at the distal common hepatic duct.FIGURE 2: Excised intact choledochal cyst with gallbladder.Both spontaneous bile duct perforation and common hepatic duct perforation are rare in children (1). The unusual combination of common hepatic duct perforation coexisting with an intact choledochal cyst has not been reported previously. Clinical presentations of spontaneous perforation of bile duct and choledochal cyst are similar. Our case suggests a common underlying pathogenesis, and supports the theory that these 2 separate entities are related to weakness of the biliary canal wall during embryogenesis with pancreaticobiliary malunion (2,3). Pathobiology of spontaneous biliary perforation could be similar to that of choledochal cyst as is evident in the present case.