Perforation Of Common Bile Duct Research Articles

Spontaneous perforation of the common bile duct: an uncommon complication of primary sclerosing cholangitis.

To describe the MR features and prognosis of patients with an uncommon complication of primary sclerosing cholangitis (PSC) characterized by a spontaneous perforation of the common bile duct (CBD) resulting in a peri-biliary collection and a pseudo-cystic appearance of the CBD. A single-center cohort of 263 patients with PSC who had at least two MRIs between 2003 and 2022 and a minimum follow-up of 1 year was retrospectively analyzed. MRI data (characteristics of CBD perforation and MR features of PSC) and clinical data were assessed. Analysis of survival without liver transplantation according to type of PSC (classical or CBD spontaneous perforation) was performed according to the Kaplan-Meier method and the curves were compared using the Log-Rank test. A total of nine (3.4%) PSC patients (5 males) had perforation of the CBD with a median age at diagnosis of 18 years compared to 33 years for the control group (p = 0.019). The peri-biliary collections were variable in appearance (fusiform or pedunculated), with a diameter ranging from 5 to 54 mm. All nine patients showed intra- and extra-hepatic bile duct involvement, dysmorphia, and high ANALI scores. The clinical course was characterized by numerous complications in most patients, and five patients (56%) underwent liver transplantation at a median time of 5 years from diagnosis, compared to 40 patients (16%) in the control group (p = 0.02). The spontaneous perforation of the common bile duct is an uncommon complication of primary sclerosing cholangitis that affects young patients and is associated with a poor prognosis. This uncommon complication of primary sclerosing cholangitis with perforation of the common bile duct resulting in a peri-biliary collection and a pseudo-cystic appearance of the common bile duct is characterized by a poor prognosis in younger patients. • Among 263 patients with primary sclerosing cholangitis (PSC), nine patients (3.6%) had an uncommon complication characterized on MRI by perforation of the common bile duct (CBD). • This perforation of the CBD was responsible in all nine cases for the formation of a peri-biliary collection, giving a pseudo-cystic appearance to the CBD. • The spontaneous perforation of the common bile duct is an uncommon complication of primary sclerosing cholangitis that affects young patients with a poor prognosis.

Spontaneous common bile duct perforation: a rare case report

Spontaneous common bile duct (CBD) perforation is a rare and life threatening clinical condition. The course of management and choice of surgical intervention depends on clinical presentation; site, size, nature of defect. It is usually reported in infants and adults due to congenital anomalies and following invasive procedure respectively but spontaneous CBD perforation in older age groups is rare without underlying cause presenting as acute abdomen. In this case report, an 82-year-old female presented to the emergency room with an acute abdomen diagnosed as spontaneous CBD perforation and its prompt management and its successful outcome.

Acute abdomen with jaundice: A clue to extrahepatic biliary tract perforation.

IntroductionAmong a plethora of causes of acute abdomen, spontaneous common bile duct perforation (SCBDP) resulting in biliary peritonitis is almost never envisaged. Since the term SCBDP is often misconstrued as absence of an identifiable cause of perforation, ‘nontraumatic perforation of CBD’ is also in parlance to exclude relatively common causes such as trauma and iatrogenic injuries. In adults, choledochal cyst, cholangitis, infection, pancreatitis, pancreatobiliary maljunction have been identified as causes of perforation, however, choledocholithiasis remains the most common cause associated with spontaneous perforation of extra hepatic bile duct.Case presentationHere we present three cases of a spontaneous common bile duct perforation that presented as acute abdomen with peritonitis. Clinical presentation, biochemical abnormalities, imaging details, treatment options, and outcome were studied. This study has been reported in line with the SCARE 2020 Guideline [1].Discussion and conclusionSpontaneous perforation of the extrahepatic bile duct is a rare but important presentation of gallstones in adults and needs a high index of suspicion during day-to-day practice. Surgeons should seek out this uncommon diagnosis in the patient for early surgical intervention and appropriate drainage to ensure survival.

Spontaneous common bile duct perforation presenting as extrahepatic bilioma: a rare clinical presentation of gall stone disease

Spontaneous common bile duct perforation presenting as extrahepatic bilioma: a rare clinical presentation of gall stone disease

750 An Unusual Presentation of a Rare Clinical Entity – A Case Report of Spontaneous Common Bile Duct Perforation in an Adult

Abstract Spontaneous or non-traumatic perforation of the extrahepatic biliary system is a rare clinical phenomenon, with few cases reported since its first mention in medical literature by Freeland in 1882. Given the rarity, misdiagnosis is common with the diagnosis almost always made during urgent exploratory laparotomy. We describe a case of spontaneous common bile duct (CBD) perforation in an 83-year-old female with no associative underlying disease process identified. The patient presented with sudden onset abdominal pain with no identifiable trigger, with minimal past medical history. Examination was remarkable for findings of epigastric tenderness and guarding. Haematological investigation was remarkable only for hyperamylasaemia and leucocytosis. Pneumoperitoneum was ruled out and following contrast CT abdomen and pelvis a working diagnosis of mild pancreatitis was made. US Abdomen and MRCP found no evidence of cholelithiasis, with minimal biliary duct dilatation. The patient continued to deteriorate on the ward, with aspiration of new intrabdominal fluid collection raising suspicion of perforated viscus. Exploratory laparotomy revealed a 1-cm defect in the CBD with frank bile leak. A T-tube was placed in the common bile duct defect, with an abdominal robertson drain also inserted. No further bile leak was identified via Tubogram, with the patient successfully discharged following multidisciplinary rehabilitation in intensive care and the ward setting. Surgeons should seek out this uncommon diagnosis in patients with hyperamylasaemia and suspected cholelithiasis who do not conform to normal biliary/pancreatic disease progression patterns.

Healed common bile duct perforation after biliary stent placement

A 54-year-old man presented to a local hospital with common bile duct (CBD) stones and obstructive jaundice. Accordingly, the patient underwent ERCP, endoscopic sphincterotomy followed by endoscopic papillary balloon dilation, and stone extraction. After the procedures, he had right upper quadrant abdominal pain. Contrast-enhanced CT of the abdomen revealed perforation of the CBD and bile leakage (A). Consequently, the patient was referred to the medical center for further treatment and immediately underwent percutaneous drainage for bile peritonitis.

Spontaneous common bile duct perforation due to choledocolithiasis accompanied with pancreaticobiliary maljunction in an adult: a case report

BackgroundSpontaneous common bile duct (CBD) perforation is an extremely rare disease in adults. We report an adult case of CBD perforation due to choledocolithiasis accompanied with pancreaticobiliary maljunction, which is, to our knowledge, the first such case report based on a search using PubMed.Case presentationA 71-year-old woman with consciousness disorder was transported to the emergency department of another hospital. She was diagnosed as having severe peritonitis with septic shock and transferred to our hospital for emergency surgery. Enhanced computed tomography (CT) revealed supraduodenal CBD dilation similar to a diverticulum and a defect of bile duct wall continuity. Furthermore, CT showed a long common channel of the pancreaticobiliary duct, so she was diagnosed as having spontaneous CBD perforation with pancreaticobiliary maljunction. Emergency surgery was performed that revealed a necrotic diverticulum-like change on the supraduodenal part, and a 2.5 × 1 cm perforation was found on the anterolateral wall of the CBD. Peritoneal lavage was performed, and CBD perforation was resolved with a T-tube. The patient suffered refractory intra-abdominal and retroperitoneal abscess formation and bleeding from the abdominal wall, which required a long period of postoperative management. The T-tube was removed on day 136, and the patient was transferred on day 153.ConclusionThe cause of CBD perforation is commonly considered to be increased intraductal pressure or weakness of the bile duct wall. In this case, pancreaticobiliary maljunction may have significantly influenced onset and the postoperative course. This case suggests that early surgical intervention and appropriate drainage are important to ensure survival.

Spontaneous common bile duct perforation in full term pregnancy: a rare case report and review of literature

BackgroundSpontaneous biliary system perforation is a rare presentation in clinical practice especially in adults. It is rarely suspected and diagnosed preoperatively due to small number of cases, vague sign and symptoms, and ambiguous presentation.Case presentationWe describe an interesting case of spontaneous perforation of the common bile duct in a 16 year-old female who presented a week after her first birth to the emergency department with complaints of diffuse abdominal pain, abdominal distention, fever, vomiting, and constipation. She was having generalized peritonitis but the etiology was unclear despite a thorough workup. She underwent exploratory laparotomy, and a perforation in the supra duodenal region of the common bile duct was found intraoperatively. The common bile duct was repaired over T-tube, and cholecystectomy was performed; the patient was recovered uneventfully.ConclusionSpontaneous biliary perforation is a rare cause of acute abdomen in adults and extremely rare in pregnancy. Its delayed diagnoses and management can lead to a high morbidity and mortality. All physicians, especially surgeons, should be aware of this possibility and consider it a cause of peritonitis on differential diagnosis particularly when there is no apparent etiology available for presentation.

Spontaneous non-traumatic common bile duct perforation presented as an acute abdomen: a rare case report

The spontaneous perforation of the biliary tract (SPBT) is an extremely rare cause of peritonitis, which was first described by Freeland in 1882, to date only around 70 cases have been reported. Here we present a case of spontaneous perforation of the biliary tract, in a patient with choledocholithiasis. A 45 years old male presented to us with acute abdomen with raised amylase and lipase s/o pancreatitis, imaging showed acute on chronic pancreatitis with impacted distal lumen in situ common bile duct (CBD) calculi. Patient was planned for ERCP with CBD clearance after his acute episode subsides. Meanwhile patient developed rigidity, guarding and distension. His second CECT showed a breach in the lower lateral segment in the CBD with gross ascites. Patient was planned for laparotomy, abdominal lavage and T-tube drainage. Patient had a stormy postoperative course. Patient recovered well and was discharged with T-tube clamped and subhepatic drain in situ. Spontaneous perforation of the extrahepatic bile duct is a rare but important presentation of gall stones. Conservative surgery that is decompression of the biliary tree and repair of the leak site over T-tube is the mainstay of treatment in the acute presentation.

Cholangioscopic finding of common bile duct perforation

Cholangioscopic finding of common bile duct perforation

Emergency case of spontaneous common bile duct (CBD) perforation

Spontaneous or non-traumatic common bile duct (CBD) perforation in children is a rare condition leading to difficulty and delay in diagnosis and resulting in high mortality. Presentation can vary significantly. Patients usually present with sudden obstructive jaundice, acholic stools, and abdominal pain and distension. Treatment tends to be surgical, consisting of CBD exploration, and possibly, repair. We report the case of a 22-month-old female with spontaneous CBD perforation. She presented with a 1-month history of increasing abdominal distension, abdominal pain, and jaundice. On exploratory laparotomy, a large amount of bile-stained ascitic fluid was drained. She was managed conservatively with 3 weeks of external intra-abdominal drains. Follow-up at 6 months showed complete recovery. Due to the rarity of spontaneous bile duct perforation, delayed diagnosis and intervention is common. Physicians must consider this diagnosis in a child with abdominal pain in order to prompt timely surgical management for a successful outcome.

A rare case of spontaneous common bile duct perforation

Spontaneous perforation of the common bile duct (CBD) in adults is an extremely rare complication of gallstones. It is challenging to establish the diagnosis pre-operatively however with increasing utility of computer tomography, there may be subtle features visualized. We describe a case of a 35 year old Indian male who presented with an acute abdomen and was found to have biliary peritonitis secondary to a spontaneous CBD perforation. Mr JJ presented with sudden onset of abdominal pain associated with vomiting and diarrhea. He had generalized abdominal peritonitis. Initial erect chest x-ray was unremarkable for free air under the diaphragm, hence a CT was performed which revealed moderate amounts of free fluid around the 2nd part of the duodenum extending along the anterior para-renal space into the pelvis, with a 4mm distal CBD stone resulting in mild upstream dilatation. The gallbladder was decompressed and the CBD wall was not well visualized in the mid-portion, raising the possibility of perforation. An exploratory laparotomy revealed generalized biliary peritonitis secondary to a 2 cm CBD perforation just distal to the cystic duct junction. Choledochoscopy confirmed the small 4mm distal CBD stone which was advanced successfully through the ampulla into the duodenum. He underwent abdominal lavage, cholecystectomy, choledochectomy and a roux-en-Y hepatico-jejunostomy reconstruction. His recovery was uneventful. Histology confirmed focal transmural necrosis of the bile duct with fibrosis and micro-abscess formation. Clinicians should be aware that whilst spontaneous extrahepatic bile duct perforations are rare, it is important as timely diagnosis can be life-saving.

Biliary Peritonitis Due to Spontaneous Perforation of the Left Intrahepatic Bile Duct in an Adult: A Case Report and Review of Literature

Spontaneous perforation of the left intrahepatic bile duct is extremely rare, especially in adults. Here, we report on a case of a 64-year-old woman who had a complaint of right upper abdominal pain for 10 days, which gradually progressed to entire abdominal pain for 3 days, and was admitted to our hospital. Relevant examinations revealed she had a normal cardiac and lung workup, but an obvious abnormal abdominal computed tomography examination, which revealed an enlarged gallbladder, choledocholithiasis with dilatation of the common bile duct (1.8 cm) and intrahepatic bile duct, and a lot of encapsulated ascites. After being given adequate fluid resuscitation and active preoperative preparation, cholecystectomy and common bile duct exploration and perforation repair operation were then performed. The postoperative course was uneventful, and she was discharged with the T-tube in situ. A choledochoscopy examination at week 6 showed the conditions of the intrahepatic and extrahepatic bile duct were good. For these patients, early diagnosis and surgical treatment are essential for good prognosis. The goal of our surgery is to stop bile leakage, resolve choledocholithiasis and cholangitis, and reconstruct the bile duct.

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

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 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

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 Common Bile Duct Perforation in an Infant Diagnosed by Hepatobiliary Radionuclide Imaging : A Case Report

Spontaneous Common Bile Duct Perforation in an Infant Diagnosed by Hepatobiliary Radionuclide Imaging : A Case Report

Spontaneous Common Bile Duct Perforation on The Background of Pancreatic Lithiasis: A Case Report and The Review of The Literatures

Spontaneous bile duct perforation (SBDP) is a relatively rare condition. The cause of SBDP is still speculative. Presentation , site of the perforation and management varies. Pancreatic lithiasis ( PL) is a very rare entity in childhood. Biliary perforation on the background of PL is still a rare event. This is a case report of 10 years old girl presented as acute abdomen with theclinical diagnosis of acute on chronic pancreatitis, for which conservative treatment followed by laparotomy was carried out.Common bile duct (CBD) perforation was found near it’s junction with cystic duct. T tube was instituted and a drain was kept in situ. Postoperative period ( POP )was uneventful. T Tube Cholangiogram was carried out on 12th postoperative day( POD ) that showed dye had passed to duodenum easily and patency and caliber of the CBD was found normal. Multiple stones were noted in the vicinity. No apparent cause of CBD perforation was found. After one month, in follow up visit the patient was found alright. She was asked to come after 3 months for further evaluation. The plan is to evaluate the patient’s conditions clinically and biochemically and to do an MRCP to see details ofpancreatic pathology. As SBDP in children with PL is a rare condition, high index of suspicion is needed for early diagnosis and proper management of such patient.DOI: http://dx.doi.org/10.3329/jpsb.v2i2.19553