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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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Sunil K, Gupta A, Verma AK, Singh AK, Kureel SN, Pandey A. Spontaneous common hepatic duct perforation in a child: A rare case report. Afr J Paediatr Surg 2018; 15:53-55. [PMID: 30829311 PMCID: PMC6419550 DOI: 10.4103/ajps.ajps_74_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Spontaneous perforation of common bile duct is a rare phenomenon; few cases are reported in literature. Hence, there is a dilemma for the management of these cases, but with modern radiological equipment and high degree of suspicion, it is possible to diagnose early. The overall prognosis of this condition is good, provided an early surgical intervention is instituted; we are reporting a case of a 6-year-old male with spontaneous perforation of common hepatic duct. Managed by repair of rent over T-tube, postoperative period was uneventful, T-tube was removed after 3 weeks, and the patient is doing well in follow-up.
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Affiliation(s)
- Kanoujia Sunil
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Archika Gupta
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ajay Kumar Verma
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Abhishek Kumar Singh
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Shiv Narain Kureel
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Anand Pandey
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
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Mohanty SK, Mahapatra T, Behera BK, Acharya B, Kumar S, Dash JR, Meher D, Sarangi MR, Sahoo SP. Spontaneous perforation of common bile duct in a young female: An intra-operative surprise. Int J Surg Case Rep 2017; 35:17-20. [PMID: 28419905 PMCID: PMC5394227 DOI: 10.1016/j.ijscr.2017.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 04/01/2017] [Accepted: 04/02/2017] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Spontaneous CBD perforation is one of the rare causes of acute abdomen in infants and extremely rare in adults. It is rarely suspected and correctly diagnosed preoperatively. PRESENTATION OF CASE A 17year old female presented to Emergency Department with sudden onset of pain and distention of abdomen, associated with vomiting and non-passage of flatus and stool for 3days and features of generalized peritonitis. On exploration, a perforation of size 0.5cm in diameter was present on the antero-lateral surface of supraduodenal part of common bile duct (CBD) below the junction of cystic duct and common hepatic duct. Cholecystectomy done and the CBD repaired over a T-tube. DISCUSSION Spontaneous perforation of bile duct should ideally manage with T-tube drainage of the CBD along with cholecystectomy. In case with distal obstruction of the CBD, a biliary enteric bypass should be done. CONCLUSION Due to the paucity of cases, the index of suspicion for this diagnosis is low. But bilious peritoneal tap, features of generalized peritonitis and absence of free gas under diaphragm in abdominal x-ray may be considered as clues for suspicion. Accordingly, Surgery remains the mainstay of treatment.
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Affiliation(s)
- Sudhir Kumar Mohanty
- Department of General Surgery, S.C.B. Medical College, Cuttack, Odisha, Pin-753007, India.
| | - Tanmaya Mahapatra
- Department of General Surgery, S.C.B. Medical College, Cuttack, Odisha, Pin-753007, India.
| | - Bharat Kumar Behera
- Department of General Surgery, S.C.B. Medical College, Cuttack, Odisha, Pin-753007, India.
| | - Bidyapati Acharya
- Department of General Surgery, S.C.B. Medical College, Cuttack, Odisha, Pin-753007, India.
| | - Supreet Kumar
- Department of General Surgery, S.C.B. Medical College, Cuttack, Odisha, Pin-753007, India.
| | - Jyoti Ranjan Dash
- Department of General Surgery, S.C.B. Medical College, Cuttack, Odisha, Pin-753007, India.
| | - Dibyasingh Meher
- Department of General Surgery, S.C.B. Medical College, Cuttack, Odisha, Pin-753007, India.
| | - Malaya Ranjan Sarangi
- Department of General Surgery, S.C.B. Medical College, Cuttack, Odisha, Pin-753007, India.
| | - Shiva Prasad Sahoo
- Department of General Surgery, S.C.B. Medical College, Cuttack, Odisha, Pin-753007, India.
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Paramhans D, Shukla S, Grover J. Spontaneous perforation of the common bile duct in an adult. Indian J Surg 2012; 75:376-8. [PMID: 24426621 DOI: 10.1007/s12262-012-0512-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Accepted: 04/25/2012] [Indexed: 11/29/2022] Open
Abstract
Spontaneous perforation of the bile duct is a rare disease in children and even rarer in adults. Although diagnostic techniques have advanced over the past years, yet most cases are diagnosed at operation. A 44-year-old woman presented with epigastric pain and vomiting of one-day duration. Abdominal distension with tenderness and guarding was present all over the abdomen. Abdominal ultrasonography showed free fluid in the peritoneal cavity with sluggish peristalsis. Abdominal and chest radiographs were normal. At laparotomy, common bile duct CBD was perforated at the junction of CBD and cystic duct. Cholecystectomy with CBD exploration was done and CBD was closed over a T-tube, and external drainage was carried out. The patient recovered well, and on the 12th postoperative day, a T-tube cholangiogram was performed which was normal. The T-tube was removed on the 14th postoperative day. One month after operation, the patient was well. Examining the patient with a suspicious thinking helps in early diagnosis and management of the patient.
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Affiliation(s)
- D Paramhans
- Department of Surgery, MGM Medical College and MY Hospital, Flat No 303, Gyatari Apartments 111,112 Geeta Nagar, Indore, India
| | - Sapna Shukla
- Department of Surgery, MGM Medical College and MY Hospital, Flat No 303, Gyatari Apartments 111,112 Geeta Nagar, Indore, India
| | - Jitendra Grover
- Department of Surgery, MGM Medical College and MY Hospital, Flat No 303, Gyatari Apartments 111,112 Geeta Nagar, Indore, India
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Abstract
A 10-year-old boy of African origin with AIDS and Stage IV Hodgkin's lymphoma presented with a short history of abdominal distension and bile ascites shown to be due to a perforation of his common bile duct. This was treated initially by laparotomy, external peritoneal drainage and endoscopic biliary stenting although without success. He then underwent a laparotomy and biliary diversion (Roux-en-Y hepaticojejunostomy) with satisfactory resolution of his bile duct pathology. Although the co-morbid conditions are likely to be contributory factors, biliary perforation in either disease has not been reported before.
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Affiliation(s)
- Erica Makin
- Department of Paediatric Surgery, King's College Hospital, Denmark Hill, SE5 9RS London, UK
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