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Yanagisawa Y, Al-Nae’eb Y, Chrysostomou P, Gercek Y. Delayed Extrahepatic Biliary Leak: A Rare Presentation 9 Years Post-Laparoscopic Cholecystectomy. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e941230. [PMID: 37971966 PMCID: PMC10660308 DOI: 10.12659/ajcr.941230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/13/2023] [Accepted: 09/19/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Biliary leaks are an important cause of the acute abdomen condition, carrying significant levels of morbidity and mortality. They are most commonly the result of acute iatrogenic or blunt trauma, with an identifiable cause. In comparison, spontaneous and delayed biliary leaks are rare phenomena occurring in the absence of recent surgery, endoscopic intervention, or trauma. Here we report the case of a 77-year-old woman presenting with acute abdominal pain, distension, and rigors caused by an extrahepatic biliary leakage 9 years after laparoscopic cholecystectomy. CASE REPORT Laparoscopic hepatobiliary intervention, rather than open surgery, is associated with increased risk of biliary tree injury, including biliary leaks, which typically arise in the immediate postoperative period. This report concerns a 77-year-old woman presenting with acute abdominal pain, distension, and rigors due to extrahepatic biliary leakage 9 years following elective laparoscopic cholecystectomy for cholelithiasis. Computed tomography (CT) showed large-volume abdominopelvic ascites with no obvious source. Intra-abdominal exploration revealed a large biloma with 2 lacerations in the gallbladder fossa. Subsequent endoscopic retrograde cholangiopancreatography (ERCP) found only a vague leak in the extrahepatic biliary tree, with no focal defect or retained biliary calculi. Intra-abdominal drainage and common bile duct (CBD) stenting were performed. Repeat ERCP undertaken 3 months later, however, identified a calculus within the CBD. CONCLUSIONS The patient's rare presentation of biliary leakage 9 years after cholecystectomy raises the question of whether the condition was delayed or spontaneous in nature. The biliary calculus identified 3 months following the leakage raises the possibility of retained biliary calculi.
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Affiliation(s)
- Yuuki Yanagisawa
- Department of Internal Medicine, Bedfordshire Hospitals NHS Trusts, Bedford Hospital, Bedford, UK
| | - Yasseen Al-Nae’eb
- Department of Gastroenterology and Hepatology, Bedfordshire Hospitals NHS Trusts, Bedford Hospital, Bedford, UK
| | - Paris Chrysostomou
- Department of Cardiology, Bedfordshire Hospitals NHS Trusts, Bedford Hospital, Bedford, UK
| | - Yuksel Gercek
- Department of General Surgery, Bedfordshire Hospitals NHS Trusts, Bedford Hospital, Bedford, UK
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Spontaneous perforation of the common bile duct in adults presenting as biliary peritonitis: a case report and literature review. Ann Med Surg (Lond) 2023; 85:460-465. [PMID: 36923738 PMCID: PMC10010815 DOI: 10.1097/ms9.0000000000000186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/24/2022] [Indexed: 03/06/2023] Open
Abstract
Spontaneous perforation of the common bile duct (SPCBD) is an exceptional disease, especially in adults. The cause is often idiopathic once trauma and choledochal cyst are excluded. Early diagnosis is often difficult because of its often-misleading appearance. Case presentation The authors report the case of a 54-year-old man, a known case of type 2 diabetes mellitus, who presented to our emergency department for acute abdominal pain that had evolved for 2 days. Clinical findings and investigations On physical examination, the patient had a fever of up to 38.5°C, and the abdomen was distended and generally tight. The abdominal computerized tomography scan confirms the presence of free fluid. In addition, the thickness of the gallbladder wall had increased in contrast with a resolved gallbladder distention. Because exploration failed to demonstrate the cause of ascites, the authors performed a diagnostic paracentesis, which revealing ascites with a dark yellow-green color, which implied bile leakage.After initial resuscitation, an emergent exploratory laparotomy was performed. The authors found biliary peritonitis secondary to SPCBD. After peritoneal lavage, the perforation was repaired over a T-tube. The postoperative course was uneventful. Histological findings were consistent with ulcerous acalculous cholecystitis. The patient was disease-free after a 3-month follow-up. Discussion SPCBD is an uncommon condition in adults, and it is rarely reported in the literature. The pathogenesis of this disease is not clear and may be related to single or multiple factors. Usually, this disease is diagnosed in the postmortem. Early diagnosis and optimal surgical treatment are challenging. Conclusion This present case highlighted the preoperative diagnostic difficulties of the SPCBD. Emergent surgical management should be instituted in the shortest time possible to reduce the high mortality.
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Luvira V, Sirichantakul N, Theeragul S, Pairojkul C. Ruptured Intraductal Papillary Neoplasm of the Bile Duct: a Rare Cause of Peritoneal Carcinomatosis. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03254-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Chronic Pancreatitis Presented with Spontaneous Bile Duct Rupture in a Child—a Case Report. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02708-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Sakamoto R, Kai K, Hiyoshi M, Imamura N, Yano K, Hamada T, Nishida T, Kawano F, Sakurahara D, Uchise Y, Yamamoto K, Kataoka H, Nanashima A. Spontaneous common bile duct perforation due to choledocolithiasis accompanied with pancreaticobiliary maljunction in an adult: a case report. Surg Case Rep 2021; 7:205. [PMID: 34495427 PMCID: PMC8426449 DOI: 10.1186/s40792-021-01290-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Spontaneous 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 PRESENTATION A 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. CONCLUSION The 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.
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Affiliation(s)
- Risa Sakamoto
- Department of Surgery, University of Miyazaki Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
| | - Kengo Kai
- Department of Surgery, University of Miyazaki Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Masahide Hiyoshi
- Department of Surgery, University of Miyazaki Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Naoya Imamura
- Department of Surgery, University of Miyazaki Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Koichi Yano
- Department of Surgery, University of Miyazaki Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Takeomi Hamada
- Department of Surgery, University of Miyazaki Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Takahiro Nishida
- Department of Surgery, University of Miyazaki Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Fumiaki Kawano
- Department of Surgery, University of Miyazaki Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Daichi Sakurahara
- Department of Surgery, University of Miyazaki Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Yukako Uchise
- Department of Surgery, University of Miyazaki Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Koji Yamamoto
- Department of Pathology, University of Miyazaki Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Hiroaki Kataoka
- Department of Pathology, University of Miyazaki Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Atsushi Nanashima
- Department of Surgery, University of Miyazaki Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
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Thompson BJ, Sherman RA. Comprehensive Review of Biliary Peritonitis. Top Companion Anim Med 2021; 44:100532. [PMID: 33781985 DOI: 10.1016/j.tcam.2021.100532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 11/26/2022]
Abstract
Biliary peritonitis is a growing concern in the canine patient and a thorough understanding of the disease will lead to better treatment outcomes. This article reviews the human and veterinary literature pertaining to biliary peritonitis including both scientific reviews and original publications. Compared to human medicine, biliary peritonitis can be difficult to diagnose preoperatively. Multiple risk factors exist increasing the likelihood of development of biliary peritonitis. Treatment recommendations center on stabilization, surgical cholecystectomy, and postoperative supportive care. Clinically, further studies on treatment and prevention in veterinary medicine are warranted.
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Amberger M, Burton N, Tissera G, Baltazar G, Palmer S. Spontaneous common bile duct perforation-A rare clinical entity. Int J Surg Case Rep 2018; 46:34-37. [PMID: 29674006 PMCID: PMC6000772 DOI: 10.1016/j.ijscr.2018.03.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 03/22/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Spontaneous common bile duct perforation is an uncommon clinical entity in both adults and children. Few case reports have been published since the first clinical description in 1882. Our work has been reported in line with SCARE criteria. PRESENTATION OF CASE Herein, we describe the case of a 28 year-old female who suffered spontaneous common bile duct perforation while admitted for choledocholithiasis. DISCUSSION The perforation occurred while in-hospital, and extensive imaging and laboratory tests characterized the disease in detail. To our knowledge, this is the first report of spontaneous common bile duct perforation witnessed from pre-perforation through definitive management. CONCLUSION Physicians and Surgeons should seek out this uncommon diagnosis in the patient with suspected Choledocholithiasis who suddenly become peritoneal on physical exam so that definitive care can be expedited.
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Affiliation(s)
- Melissa Amberger
- Department of Surgery, SBH Health System, Bronx, NY, USA; New York Institute of Technology College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY, USA; Sophie Davis School of Biomedical Education, New York, NY, USA.
| | - Noelle Burton
- Department of Surgery, Montefiore New Rochelle, New Rochelle, NY, USA
| | | | - Gerard Baltazar
- Department of Surgery, SBH Health System, Bronx, NY, USA; New York Institute of Technology College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY, USA; Sophie Davis School of Biomedical Education, New York, NY, USA
| | - Shani Palmer
- Department of Surgery, Montefiore New Rochelle, New Rochelle, NY, USA
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Faridi SH, Aslam M, Siddiqui B, Khan RA. Challenges in the diagnosis and management of spontaneous bile duct perforation: A case report and review of literature. J Indian Assoc Pediatr Surg 2015; 20:143-5. [PMID: 26166986 PMCID: PMC4481627 DOI: 10.4103/0971-9261.159030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We report a case of 14-year-old male, who presented to us with complaints of severe pain in abdomen, vomiting, and inability to pass feces and flatus. He was diagnosed as a case of peritonitis after careful history, examination, and investigations. The exact cause of peritonitis was not known. Exploratory laparotomy was done, and it was found that there was perforation of the right hepatic duct about 1 cm proximal to its confluence with the left hepatic duct. Perforation was closed around the T-tube. Postoperative T-tube cholangiogram was done after 3 weeks which confirmed the free passage of dye into the duodenum, and there was no leakage of dye. T-Tube was removed 4 weeks after the operation, and the patient was discharged in satisfactory condition. Postoperative follow-up was done for 3 months, and it was uneventful.
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Affiliation(s)
- Shahbaz Habib Faridi
- Department of Surgery, JN Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Mohammed Aslam
- Department of Surgery, JN Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Bushra Siddiqui
- Department of Pathology, JN Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Rizwan A Khan
- Department of Paediatric Surgery, JN Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Clinical value of ultrasound in diagnosing pediatric choledochal cyst perforation. AJR Am J Roentgenol 2015; 204:630-5. [PMID: 25714296 DOI: 10.2214/ajr.14.12935] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE. The objective of our study was to evaluate ultrasound images of pediatric patients with choledochal cyst perforation and establish imaging findings that can be used as the basis for timely surgical intervention. MATERIALS AND METHODS. Our study group was composed of 23 pediatric patients who presented with various symptoms of acute abdomen and were admitted to our institution between 1996 and 2013. All had undergone preoperative ultrasound examination and had a final diagnosis of choledochal cyst perforation that was confirmed at exploratory laparotomy. The imaging and surgical data were reviewed and analyzed retrospectively. RESULTS. The 23 patients included nine males and 14 females with a mean age of 2.55 years and mean disease duration of 12.48 days. The most common initial diagnoses were intestinal obstruction and peritonitis. Real-time ultrasound imaging with multislice views revealed characteristics of choledochal cyst perforation, including changes in the shape of the bile duct, loss of local gallbladder tension, thickened gallbladder wall, changes in the morphology of the gallbladder, and peritoneal effusion. The inability to visualize the gallbladder, gallbladder enlargement, the presence of gallbladder sludge and of pebblelike stones, and dilatation of the intrahepatic ducts were also noted on ultrasound. Choledochectasia was present in a majority of the patients (17/23), and ascites was seen in all 23 patients. The ultrasound signs corresponded to the surgical findings, thus showing the high clinical diagnostic value of ultrasound in this setting. CONCLUSION. Real-time ultrasound imaging-with its multislice views and good reproducibility-allows definitive preoperative diagnosis of pediatric choledochal cyst perforation.
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Garg PK, Jain BK, Pandey SD, Rathi V, Puri AS. Simultaneous non-traumatic perforation of the right hepatic duct and gallbladder: an atypical occurrence. Malays J Med Sci 2012; 19:77-80. [PMID: 23610553 PMCID: PMC3629668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 02/08/2012] [Indexed: 06/02/2023] Open
Abstract
Simultaneous non-traumatic perforation of the extrahepatic bile duct and the gallbladder is an uncommon occurrence that has been infrequently reported. We describe a patient with a spontaneous perforation of both the extrahepatic bile duct and the gallbladder. A contrast-enhanced computed tomography (CECT) scan of the abdomen and endoscopic retrograde cholangiopancreatography (ERCP) demonstrated a perforation of the gallbladder and a free leak from the right hepatic duct, respectively. Endoscopic biliary drainage following a sphincterotomy and biliary stent placement led to a dramatic improvement in the patient's general condition. He was subsequently scheduled to undergo an elective cholecystectomy. Repeat ERCP performed at 4 weeks after the initial stenting showed a normal cholangiogram and a distally migrated stent, which was there after removed. However, early stent removal led to re-perforation of hepatic duct and gallbladder. A repeat endoscopic biliary drainage did not help, and the patient developed biliary peritonitis. Surgical exploration revealed a perforation at the fundus of the gallbladder, 400 ml of biliopurulent collection and a frozen Calot's triangle. A subtotal cholecystectomy, gall stone removal, and a thorough peritoneal lavage were undertaken. The patient improved postoperatively. The second biliary stent was removed after 4 months. This case report highlights the role of endoscopic biliary drainage in the management of an extrahepatic bile duct perforation and warns against the early removal of a biliary stent.
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Affiliation(s)
- Pankaj Kumar Garg
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi 110095, India
| | - Bhupendra Kumar Jain
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi 110095, India
| | - Satya Deo Pandey
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi 110095, India
| | - Vinita Rathi
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi 110095, India
| | - Amarendra Singh Puri
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi 110095, India
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