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Pattanaik P, Pattanaik SK. Spontaneous perforation of the common hepatic duct in a child: an unexpected intraoperative encounter. BMJ Case Rep 2024; 17:e261041. [PMID: 39013619 DOI: 10.1136/bcr-2024-261041] [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] [Indexed: 07/18/2024] Open
Abstract
Spontaneous or idiopathic bile duct perforation is rare, mostly seen in children from 25 weeks of gestation to 7 years of age, with the confluence of cystic duct and common hepatic duct (CHD) being the most common site. The exact aetiopathogenesis remains elusive and poorly understood, leading to a lack of consensus on its optimal management. The condition is often diagnosed intraoperatively. We present a case of spontaneous perforation of the CHD in a boy in his middle childhood, alongside a review of relevant literature. The patient presented with acute abdomen and pyobiliary peritonitis, for which a hollow viscus perforation was suspected. An emergent laparotomy revealed a 0.5 cm CHD perforation. Surgical intervention involved T-tube insertion and drainage, leading to a successful recovery. This case underscores the challenge of preoperative diagnosis, necessitating prompt exploration after initial resuscitation. There is a need for clinical vigilance and tailored surgical approaches.
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Affiliation(s)
- Prasoon Pattanaik
- Surgery, Sriram Chandra Bhanja Medical College and Hospital, Cuttack, Odisha, India
| | - Sushila Kumar Pattanaik
- PG Department of Surgery, Post Graduate Institute of Medical Education and Research and Capital Hospital, Bhubaneswar, Odisha, India
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2
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Mori Y, Izumi J, Okuyama A, Mori N, Niwa M. Nontraumatic rupture of the common bile duct: A case of successful diagnosis and conservative treatment in an elderly patient. Geriatr Gerontol Int 2023; 23:967-968. [PMID: 37918824 DOI: 10.1111/ggi.14724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023]
Affiliation(s)
- Yuri Mori
- Department of Radiology, Yokote Municipal Hospital, Yokote, Japan
| | - Junichi Izumi
- Department of Radiology, Yokote Municipal Hospital, Yokote, Japan
| | - Atsushi Okuyama
- Department of Gastroenterology, Yokote Municipal Hospital, Yokote, Japan
| | - Naoko Mori
- Department of Radiology, Akita University Graduate School of Medicine, Akita, Japan
| | - Makoto Niwa
- Department of Surgery, Yokote Municipal Hospital, Yokote, Japan
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Symeonidis D, Bompou E, Samara AA, Kissa L, Tepetes K. An Unusual Cause of Biliary Peritonitis on the Background of Acute Pancreatitis: A Case Report. Surg J (N Y) 2022; 8:e227-e231. [PMID: 36062181 PMCID: PMC9439879 DOI: 10.1055/s-0042-1756284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/01/2022] [Indexed: 11/01/2022] Open
Abstract
Abstract
Introduction Acute pancreatitis can cause a wide variety of local complications, sometimes pretty unusual. In the present report, we present a rather unusual cause of biliary peritonitis on the background of acute pancreatitis.
Case Presentation A 41-year-old female patient with biliary acute pancreatitis and concomitant choledocholithiasis required an urgent laparotomy due to signs of sepsis and peritoneal irritation after a trial of conservative management. During laparotomy, the diagnosis of biliary peritonitis was established. Surprisingly, a residual gallstone obstructing the common bile duct at the level of the ampulla was causing bile to reflux, through the common channel, into the main pancreatic duct and subsequently into a partially ruptured acute pancreatic necrotic collection.
Conclusion Dealing with the unexpected is a constant challenge for the surgical team dealing with acute pancreatitis patients. Although deferring surgical intervention during the course of acute pancreatitis, as much as possible, is the ideal strategy, this is not always possible. Deciding the treatment strategy based on the patients' clinical condition represents the most appropriate approach.
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Affiliation(s)
- Dimitrios Symeonidis
- Department of Surgery, University Hospital of Larissa, Mezourlo, Larissa, Greece
| | - Efrosyni Bompou
- Department of Surgery, University Hospital of Larissa, Mezourlo, Larissa, Greece
| | - Athina A. Samara
- Department of Surgery, University Hospital of Larissa, Mezourlo, Larissa, Greece
| | - Labrini Kissa
- Department of Surgery, University Hospital of Larissa, Mezourlo, Larissa, Greece
| | - Konstantinos Tepetes
- Department of Surgery, University Hospital of Larissa, Mezourlo, Larissa, Greece
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Kerkeni Y, Thamri F, Zouaoui A, Aziza B, Jouini R. Spontaneous perforation of common hepatic duct: an intraoperative surprise. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-022-00159-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Pediatric spontaneous bile duct perforation is one of the rare causes of acute abdomen in infants. With a highly variable presentation, diagnosis and treatment can prove challenging. We report a case of spontaneous common hepatic duct perforation mistaken for appendicular peritonitis.
Case presentation
An otherwise healthy 3-year-old boy presented to the emergency department with complaints of abdominal pain, distention, bilious vomiting, and fever evolving for 4 days. Preoperative ultrasound was suggestive of appendicular peritonitis. Laparotomy revealed abundant biliary fluid, a distended gallbladder with thickened and inflammatory wall, and a macroscopically normal appendix. Intraoperative cholangiography showed a leak of contrast from the anterior wall of the common hepatic duct, 2–3 mm below the upper biliary confluence and 2 cm above the junction of the cystic duct to the common hepatic duct. A cholecystostomy was performed, and two external intraabdominal drains were placed. A retrograde cholangiogram was performed on postoperative day 21 showing no extravasation of contrast product. The patient was discharged on postoperative day 25.
Conclusion
Spontaneous perforation of the common hepatic duct is a rare phenomenon. It should be considered as a differential diagnosis in pediatric patients that present with unexplained peritonitis. The optimal method of diagnosis and management remains controversial.
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Matsuo H, Katayama K, Hayasaki A, Iizawa Y, Endo M, Murata T, Mizuno S, Dohi K. Biliary peritonitis due to liver cyst rupture in autosomal dominant polycystic kidney disease. BMC Gastroenterol 2021; 21:267. [PMID: 34167461 PMCID: PMC8223295 DOI: 10.1186/s12876-021-01845-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/14/2021] [Indexed: 11/23/2022] Open
Abstract
Background Autosomal dominant polycystic kidney disease (ADPKD) is the most frequent genetic kidney disease and polycystic liver disease is its major extrarenal manifestation, however biliary peritonitis due to a liver cyst rupture is extremely rare. Case presentation The patient was a 71-year-old Japanese woman who was diagnosed with ADPKD 3 years previously and developed right abdominal pain suddenly 1 month previously. As abdominal computed tomography (CT) showed a ruptured liver cyst in the right lobe, she was admitted to our hospital. Her symptoms improved with conservative management and she was discharged from the hospital after 1 week. Although she was asymptomatic for a while, she noticed abdominal distension and general malaise at 1 month after hospital discharge. Since abdominal CT showed massive ascites, she was admitted to our hospital again. A physical examination revealed abdominal distention without tenderness. Her serum creatinine, alkaline phosphatase, γ-glutamyl transpeptidase, total bilirubin, and CA19-9 were elevated. Abdominal paracentesis revealed amber transparent ascites and the bilirubin and CA19-9 concentrations were high. She was diagnosed with biliary peritonitis due to a ruptured liver cyst. Hemodialysis treatment was initiated with drainage of the ascites. The outflow of the ascites was no tendency to decrease and drip infusion cholangiography (DIC)-CT revealed a communication between the ruptured cyst and an intrahepatic bile duct. On day 31, she was transferred to a university hospital and abdominal surgery was performed. After removing the necrotic roof of the ruptured cyst on the right liver lobe, the orifice of the bile leakage was sutured. Cholecystectomy was performed and cholangiography showed no stones in the common bile duct. Abdominal CT one month after the operation showed no recurrence of ascites and she was discharged on day 49. Hemodialysis treatment was discontinued immediately after discharge because urine volume increased and her creatinine level decreased. There has been no recurrence of ascites since then.
Conclusions While rare, biliary peritonitis can occur in association with the rupture of a liver cyst in ADPKD patients due to communication between the cyst and the intrahepatic bile duct, and DIC-CT should be recommended when biliary cyst rupture is suspected.
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Affiliation(s)
- Hiroshi Matsuo
- Kidney Center, Suzuka Kaisei Hospital, Suzuka, Japan.,Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Kan Katayama
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Aoi Hayasaki
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yusuke Iizawa
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Mayumi Endo
- Kidney Center, Suzuka Kaisei Hospital, Suzuka, Japan.,Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Tomohiro Murata
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Shugo Mizuno
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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Fukui T, Chochi T, Maeda T, Lee C, Wada Y, Ohashi M, Tashiro J, Arai M, Kurata M, Yoshida T, Konishi F. Biliary Peritonitis Caused by Spontaneous Bile Duct Rupture in the Left Triangular Ligament of the Liver after Endoscopic Sphincterotomy for Choledocholithiasis. Case Rep Gastroenterol 2021; 15:53-61. [PMID: 33613164 PMCID: PMC7879265 DOI: 10.1159/000510932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/11/2020] [Indexed: 12/15/2022] Open
Abstract
Spontaneous bile duct rupture is a rare condition in adults, with only 70 cases reported. Increased bile duct wall pressure may lead to rupture and biliary peritonitis. In this patient, the bile duct ruptured in the hepatic left triangular ligament. A 91-year-old man underwent endoscopic retrograde cholangiopancreatography for choledocholithiasis and endoscopic retrograde biliary drainage (ERBD) placement. One week later, removal of the ERBD and common bile duct stones and an endoscopic sphincterotomy (EST) were performed. Four days later, the patient had abdominal pain, increased inflammatory reaction, and jaundice. Abdominal computed tomography showed ascites, bile duct dilatation and fluid collection under the liver (10 cm in diameter). Emergency surgery was performed to drain the fluid. On laparotomy, encapsulated biliary ascites was seen. To search for the site of the leak, after cholecystectomy, a tube (C-tube) was inserted into the common bile duct via cystic duct stump. Because of uncontrollable bleeding, after packing with surgical gauze, the operation was temporarily stopped. The next day, reoperation was performed. Intraoperative cholangiography with contrast dye revealed the perforation site in the left triangular ligament and a partial resection was performed. Bile excretion from the C-tube was subsequently observed, but the patient's jaundice did not improve. Although endoscopic retrograde cholangiopancreatography revealed that the EST site was normal, ERBD was placed again, and the jaundice gradually improved. Although EST was performed in this case, biliary peritonitis resulting from spontaneous bile duct rupture occurred. This case was very informative because biliary perforation may occur even after EST.
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Affiliation(s)
- Taro Fukui
- Surgery Division, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Takeshi Chochi
- Surgery Division, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Toru Maeda
- Surgery Division, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Chunyong Lee
- Surgery Division, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Yohnosuke Wada
- Surgery Division, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Masaki Ohashi
- Surgery Division, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Jun Tashiro
- Gastroenterology Division, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Masahiro Arai
- Gastroenterology Division, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Morito Kurata
- Department of Comprehensive Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Fumio Konishi
- Surgery Division, Nerima Hikarigaoka Hospital, Tokyo, Japan
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7
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Total laparoscopic management of spontaneous biliary perforation. Clin J Gastroenterol 2020; 13:818-822. [PMID: 32270435 DOI: 10.1007/s12328-020-01122-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Abstract
Spontaneous biliary perforation (SBP) in pediatrics is rare and historically has been treated with laparotomy for attempted repair and cholecystectomy. In recent years, management has evolved into a conservative approach, opting for cholecystostomy and peritoneal drainage over cholecystectomy. In this case, we report the first successful conservative management of SBP using an exclusively laparoscopic approach without cholecystectomy in a pediatric patient.
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Ghazy RM, Khedr MA. Neonatal cholestasis: recent insights. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2019. [DOI: 10.1186/s43054-019-0009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractBackgroundNeonatal physiological jaundice is a common benign condition that rarely extends behind the second week of life; however, it may interfere with the diagnosis of a pathological condition termed neonatal cholestasis (NC). The latter is a critical, uncommon problem characterized by conjugated hyperbilirubinaemia. This review aims to highlight the differences between physiological and pathological jaundice, identify different causes of NC, and provide a recent approach to diagnosis and management of this serious condition.Main textNC affects 1/2500 live births, resulting in life-threatening complications due to associated hepatobiliary or metabolic abnormalities. NC is rarely benign and indicates the presence of severe underlying disease. If jaundice extends more than 14 days in full-term infants or 21 days in preterm infants, the serum bilirubin level fractionated into conjugated (direct) and unconjugated (indirect) bilirubin should be measured. A stepwise diagnostic approach starts with obtaining a complete history, and a physical examination which are valuable for the rapid diagnosis of the underlying disease. The most frequently diagnosed causes of NC are biliary atresia (BA) and idiopathic neonatal hepatitis (INH). The early diagnosis of NC ensures more accurate management and better prognosis. Despite the unavailability of any specific treatments for some causes of NC, the patient can benefit from nutritional management and early medical intervention. Future research should attempt to shed light on methods of screening for NC, especially for causes that can be effectively treated either through proper nutritional support, appropriate chemotherapeutic management, or timely surgical intervention.ConclusionFurther attention should be paid for diagnosis and treatment of NC as it may be misdiagnosed as physiological jaundice; this may delay the proper management of the underlying diseases and aggravates its complications.
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9
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Biliary Peritonitis Due to Spontaneous Perforation of the Left Intrahepatic Bile Duct in an Adult: A Case Report and Review of Literature. Int Surg 2018. [DOI: 10.9738/intsurg-d-14-00264.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
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10
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Gerrard AD, Thind G, Date R. Primary Bile Duct Perforation Associated with Pancreatitis. ACG Case Rep J 2018; 5:e45. [PMID: 29951560 PMCID: PMC6013686 DOI: 10.14309/crj.2018.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 03/23/2018] [Indexed: 11/17/2022] Open
Abstract
Primary bile duct perforation is rare in adults. It commonly results in biliary peritonitis and high morbidity and mortality. We present a 72-year-old man who was initially admitted with biochemically diagnosed pancreatitis who was found to have a bile duct perforation and bile collection limited to the lesser sac. This presented a diagnostic challenge and, due to its containment, did not result in generalized biliary peritonitis, which is usually associated with this condition. His condition was managed with stenting with endoscopic retrograde cholangiopancreatography.
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Affiliation(s)
- Adam Daniel Gerrard
- Upper Gastrointestinal Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Gagandeep Thind
- Radiology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Ravindra Date
- Upper Gastrointestinal Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
- The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
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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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Gómez-Torres GA, Rodríguez-Navarro FM, López-Lizárraga CR, Bautista-López CA, Ortega-García OS, Becerra-Navarro G, Águila-Barragán A, Ploneda-Valencia CF. Acute Abdomen Secondary to a Spontaneous Perforation of the Biliary Tract, a Rare Complication of Choledocholithiasis. Int J Surg Case Rep 2017; 41:255-258. [PMID: 29112915 PMCID: PMC5675728 DOI: 10.1016/j.ijscr.2017.10.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/20/2017] [Accepted: 10/24/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The spontaneous perforation of the biliary tract (SPBT) is an extremely rare cause of peritonitis, which was first described by Freeland in 1982, 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, which was treated with ultrasound-guided drainage and ERCP. CASE REPORT A 51-year-old male was admitted to the emergency room for 15-day evolution jaundice, localized pain in the right flank and hypochondrium of 3days. He had a history of cholecystectomy 15 years ago and 4 episodes of cholangitis, the last one in 2015. A magnetic resonance imaging (MRI) was performed, that showed evidence of choledocholithiasis, in addition to a possible biliary leakage. The patient was treated with ultrasound-guided drainage and ERCP successfully. DISCUSSION Spontaneous perforation of the biliary tract is a disease entity in which wall of the extrahepatic or intrahepatic duct is perforated without any traumatic or iatrogenic injury. The clinical presentation varies from nonspecific abdominal pain to biliary peritonitis, in most of the cases forming bilomas. Universal management involves decompression of the biliary tree and repair of the leak site. CONCLUSION The spontaneous perforation of the biliary tract is a disease that represents a diagnostic challenge. The treatment in the patients with SPBT is not well established and has to be individualized for each case, depending on the history of the patient, the site of perforation, the time of evolution, the suspicion of infection, and the patient status.
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Affiliation(s)
- G A Gómez-Torres
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Mexico.
| | - F M Rodríguez-Navarro
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Mexico
| | - C R López-Lizárraga
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Mexico
| | - C A Bautista-López
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Mexico
| | - O S Ortega-García
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Mexico
| | - G Becerra-Navarro
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Mexico
| | - A Águila-Barragán
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Mexico
| | - C F Ploneda-Valencia
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Mexico
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13
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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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Spontaneous Perforation of Common Bile Duct: A Rare Presentation of Gall Stones Disease. Case Rep Gastrointest Med 2016; 2016:5321304. [PMID: 27433361 PMCID: PMC4940531 DOI: 10.1155/2016/5321304] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/06/2016] [Indexed: 11/17/2022] Open
Abstract
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.
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Case report of non-traumatic spontaneous intrahepatic bile duct rupture in an adult. Int J Surg Case Rep 2016; 21:104-6. [PMID: 26963260 PMCID: PMC4802412 DOI: 10.1016/j.ijscr.2016.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 02/08/2016] [Accepted: 02/11/2016] [Indexed: 12/05/2022] Open
Abstract
Spontaneous bile duct perforation is a rare condition. Surgical treatment should be indicated only following careful consideration of the patient’s clinical and comorbidity status.
Introduction Spontaneous rupture of the biliary duct, a rare condition in adults, is difficult to diagnose preoperatively and presents with acute abdominal symptoms. The treatment of this rare condition should be based on the individual’s clinical status. We present peripheric biliary duct rupture (segment three) treated with external segment III drainage and postoperative endoscopic removal of the stones. Presentation of case An 82-year-old male patient presented with abdominal pain and fever. An ultrasound (US) revealed a solid gall stone lesion, 3 cm in diameter, in liver segments three and four with additional intra-abdominal fluid accumulation without coexisting free air. A diagnostic laparotomy was then performed because the patient had signs of peritonitis. Exploration revealed a biliary leakage from the posterior surface of segment three. An external biliary drainage catheter was inserted to the perforated segment III duct via a 6 French (6F) feeding catheter. He was discharged after 10 days and his intracholedocal stent was removed postoperative after three months. The patient continues to be monitored. Discussion Spontaneous rupture of the intrahepatic biliary duct is a rare condition. Although occurrence is frequently reported as spontaneous, the majority of cases are related to choledocholithiasis. The role of surgical treatment in cases of spontaneous bile duct rupture is unclear. When biliary peritonitis is present, drainage of contaminated biliary fluid, T-tube drainage, closure of the biliary duct, as well as primary disease conditions, should be reviewed prior to treatment. Conclusion Surgical treatment of spontaneous biliary duct rupture should be indicated only after careful consideration of the patient’s clinical and comorbidity status.
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Mohammed Ilyas MI, Tieman J, Alkhoury F. Laparoscopic single stage procedure for perforated choledochal cyst. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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17
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Gupta R, Paul R, Sharma S, Sharma SB, Mathur P. Spontaneous biliary perforation in a 7-year-old child. FORMOSAN JOURNAL OF SURGERY 2015. [DOI: 10.1016/j.fjs.2015.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Jeanty C, Derderian SC, Hirose S, Lee H, Padilla BE. Spontaneous biliary perforation in infancy: Management strategies and outcomes. J Pediatr Surg 2015; 50:1137-41. [PMID: 25783338 DOI: 10.1016/j.jpedsurg.2014.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 07/20/2014] [Accepted: 07/28/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Infantile spontaneous biliary perforation is rare with variable management strategies ranging from nonoperative treatment to complex operations such as biliary-enteric reconstruction. Biliary fistula and portal vein thrombosis are known complications, though outcomes are poorly defined. METHODS We assessed the incidence of spontaneous biliary perforation in infants <1 year old using a population database. Next, we describe 4 patients treated at our institution and review all reported cases within the past 25 years. RESULTS The incidence of spontaneous biliary perforation is 1.5 in 1,000,000 live births. Over the past 25 years, 90 cases were reported, over half of which were initially managed with a surgical drainage procedure. The most common reason for failure of this strategy was CBD obstruction. Our 4 patients were successfully managed without biliary reconstruction despite 2 presenting with CBD obstruction. Reported complications occurred in 22% of patients, most frequently biliary fistula requiring delayed biliary reconstruction. CONCLUSIONS Surgical drainage is an effective method for treatment of infantile spontaneous biliary perforation; however a persistent biliary fistula should prompt evaluation for distal CBD obstruction. Though biliary-enteric anastomosis is the historic procedure of choice for persistent fistula, with improvements in endoscopic and percutaneous treatment, extensive biliary reconstruction may be avoided in the future.
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Affiliation(s)
- Cerine Jeanty
- University of California, San Francisco, Campus Box 0570, 513 Parnassus Avenue, San Francisco, CA 94143-0570, United States.
| | - S Christopher Derderian
- University of California, San Francisco, Campus Box 0570, 513 Parnassus Avenue, San Francisco, CA 94143-0570, United States
| | - Shinjiro Hirose
- University of California, San Francisco, Campus Box 0570, 513 Parnassus Avenue, San Francisco, CA 94143-0570, United States
| | - Hanmin Lee
- University of California, San Francisco, Campus Box 0570, 513 Parnassus Avenue, San Francisco, CA 94143-0570, United States
| | - Benjamin E Padilla
- University of California, San Francisco, Campus Box 0570, 513 Parnassus Avenue, San Francisco, CA 94143-0570, United States
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Hooft N, Notrica DM, Bae JO. Spontaneous bile duct perforation with cystic fibrosis and meconium ileus. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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20
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Spontaneous bile duct perforation in an infant, managed with simple drainage. ANNALS OF PEDIATRIC SURGERY 2015. [DOI: 10.1097/01.xps.0000462926.99853.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Başara I, Seçil M. Spontaneous asymptomatic gallbladder perforation. Quant Imaging Med Surg 2014; 4:212-3. [PMID: 24914424 DOI: 10.3978/j.issn.2223-4292.2014.03.03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 03/17/2014] [Indexed: 12/14/2022]
Abstract
Gallstone disease is common. However, a proportion of patients are asymptomatic and remain undiagnosed until the occurrence of complications. Common complications include acute cholecystitis, biliary obstruction, acute pancreatitis and cholangitis. Severe complications include gallbladder perforation, Mirizzi syndrome and fistula formation are usually associated with significant morbidity and mortality. We report a case of asymptomatic spotaneous gallbladder perforation due to acute cholecystitis.
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Affiliation(s)
- Işıl Başara
- Dokuz Eylül University, Department of Radiology, Izmir, Turkey
| | - Mustafa Seçil
- Dokuz Eylül University, Department of Radiology, Izmir, Turkey
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One-staged or two-staged surgery for perforated choledochal cyst with bile peritonitis in children? A single center experience with 27 cases. Pediatr Surg Int 2014; 30:287-90. [PMID: 24463980 DOI: 10.1007/s00383-014-3461-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To report the authors' experience in the management of perforated choledochal cyst with bile peritonitis (PCC) in children. METHODS Medical records of all children undergoing surgery for PCC at our hospital from May, 2005 to January, 2013 were reviewed. RESULTS Twenty seven patients were identified, with a median age of 2 years. The clinical manifestations were abdominal pain (96.3 %), abdominal distention (92.6 %), vomiting (88.9 %), jaundice (74.1 %), fever (70.4 %), acholic stool (51.8 %), abdominal tenderness (92.6 %), peritoneal signs (74.1 %), and palpable mass (18.5 %). Duration of the acute symptoms ranged from 1 to 30 days (median 3 days). Median size of the choledochal cysts was 3 cm (range 1.5-18 cm). Before January 2008, four cases were treated by two-staged surgery and only one case by one-staged surgery. Since then, all remaining 22 cases were treated by the one-staged surgery. There was no anastomotic leakage and all patients were discharged in good health. The mean postoperative stay was 7.6 ± 2.5 days for the one-staged group. No complication was noted at a median follow-up of 24 months. CONCLUSIONS One-staged definitive repair is feasible, safe and should be the treatment of choice for most cases of childhood PCC in experienced centers.
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Paediatric infant presenting with an atypical spontaneous biliary perforation. ANNALS OF PEDIATRIC SURGERY 2014. [DOI: 10.1097/01.xps.0000438126.32652.87] [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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Murphy JT, Koral K, Soeken T, Megison S. Complex spontaneous bile duct perforation: an alternative approach to standard porta hepatis drainage therapy. J Pediatr Surg 2013; 48:893-8. [PMID: 23583154 DOI: 10.1016/j.jpedsurg.2013.01.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 01/11/2013] [Accepted: 01/15/2013] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Spontaneous perforation of the bile duct (SPBD) is a rare abnormality of the extrahepatic biliary tree in infants. Limited porta hepatis exploration and drainage of the bile-soiled peritoneum are often sufficient treatment. Here, we describe three cases of SPBD, one of which required complex multi-disciplinary interventions for restoration of biliary continuity. METHODS Three infants with bilious ascites from spontaneous biliary perforation were reviewed. Metrics included age, presenting symptoms, diagnostic tests, interventions performed, and outcomes. RESULTS The presenting symptoms of all three infants were bilious ascites, sepsis, lethargy, anorexia, fever and persistent emesis. SPBD was confirmed pre-operatively by HIDA scan (hepatobiliary scintigraphy) in each case. Intra-operative, trans-cholecystic cholangiogram confirmed SBDP in two cases. Two of the infants were successfully treated with placement of a cholecystostomy tube and porta hepatis drains. The third infant, having failed multiple similar drainage procedures, required percutaneous transhepatic drainage of a persistent porta hepatis biloma. Ultimately percutaneous, transhepatic cannulation of the extra-hepatic biliary tree for prolonged stenting was required to successfully treat this biliary perforation. CONCLUSION Complex spontaneous biliary perforation may require extensive interventions if the perforation fails to resolve with standard porta hepatis drainage. Access of the biliary tree via Interventional Radiology procedures for complex biliary disease of this type is novel and presents an alternative to traditional open surgical treatment and control of spontaneous biliary perforations.
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Affiliation(s)
- Joseph T Murphy
- Department of Pediatric Surgery, Children's Medical Center Dallas Texas, University of Texas Southwestern Medical Center Dallas, TX 75235, USA.
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25
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Pereira E Cotta MV, Yan J, Asaid M, Ferguson P, Clarnette T. Conservative management of spontaneous bile duct perforation in infancy:: case report and literature review. J Pediatr Surg 2012; 47:1757-9. [PMID: 22974619 DOI: 10.1016/j.jpedsurg.2012.06.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 06/07/2012] [Accepted: 06/19/2012] [Indexed: 11/30/2022]
Abstract
Spontaneous bile duct perforation in infants is rare, with less than 150 cases having been reported worldwide. With a highly variable presentation, diagnosis and treatment can prove challenging, and outcomes are not without significant morbidity. We herewith report the case of an 8-week-old male infant with spontaneous bile duct perforation. He initially presented with abdominal sepsis and septated ascites on ultrasound, which was confirmed as bilious on ascitic tap and at diagnostic laparoscopy. Intraoperative cholangiogram demonstrated a localized leak at the junction of the cystic and common bile duct. Conversion to laparotomy was ultimately required with cholecystostomy, and 2 external intraabdominal drains were placed. He was subsequently managed conservatively with 4 weeks external drainage, with a repeat cholangiogram at 6 weeks, demonstrating successful resolution of the leak. The reported case supports the findings of changing practices in the existing literature. We suggest that, in cases of spontaneous bile duct perforation with no distal obstruction, dissection and surgery to the biliary tree are not always required. Conservative management with simple external drainage can have its complications but, as shown here, can be a successful treatment option in terms of healing of perforation.
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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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Gobbi D, Leon FF, Gasparella P, Gamba P, Betalli P. Conservative treatment of spontaneous biliary perforation. Pediatr Int 2011; 53:594-5. [PMID: 21851496 DOI: 10.1111/j.1442-200x.2010.03307.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Dalia Gobbi
- Division of Pediatric Surgery, University of Padova, Padova, Italy.
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Evans K, Marsden N, Desai A. Spontaneous perforation of the bile duct in infancy and childhood: a systematic review. J Pediatr Gastroenterol Nutr 2010; 50:677-81. [PMID: 20400907 DOI: 10.1097/mpg.0b013e3181d5eed3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Lee MJ, Kim MJ, Yoon CS. MR cholangiopancreatography findings in children with spontaneous bile duct perforation. Pediatr Radiol 2010; 40:687-92. [PMID: 20076954 DOI: 10.1007/s00247-009-1447-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 09/24/2009] [Accepted: 09/25/2009] [Indexed: 12/31/2022]
Abstract
BACKGROUND Spontaneous bile duct perforation (SBP) is rare in children. Early diagnosis is important because the condition can be treated surgically. OBJECTIVE The purpose of this study is to report MR cholangiopancreatography (MRCP) findings of SBP and to evaluate the usefulness of MRCP. MATERIALS AND METHODS Over the last 10 years, three children (1 boy, 2 girls; ages 3, 4 and 15 months) underwent US, MRCP and hepatobiliary scintigraphy preoperatively and were surgically confirmed to have extrahepatic bile duct perforation. RESULTS US showed ascites in all children and a choledochal cyst in one. On MRCP, a moderate-to-large volume of ascites was seen in addition to a loculated fluid collection at the porta hepatis. MRCP also depicted the low insertion of the cystic duct and choledochal cyst in each case. Hepatobiliary scintigraphy showed bile leak from the region of the porta hepatis extending to the whole abdomen. According to the surgical findings, the perforation site was around the junction of the cystic duct and the common hepatic duct in all children. CONCLUSION In children with SBP, MRCP can depict the loculated fluid collection adjacent to the perforation site and associated bile duct anomalies.
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Affiliation(s)
- Mi-Jung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University, College of Medicine, 250 Seongsanno (134 Sinchon-dong), Seodaemungu, Seoul, 120-752, Korea
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Rastogi R, Rastogi V. Case report: Retroperitoneal biliary fluid collections secondary to common bile duct rupture - an unusual complication of choledocholithiasis in a child. Indian J Radiol Imaging 2009; 18:232-5. [PMID: 19774165 PMCID: PMC2747443 DOI: 10.4103/0971-3026.41835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Rupture of the common bile duct (CBD) in a child secondary to choledocholithiasis is a rare event. In this article, the authors describe a child who presented with an acute abdomen due to CBD rupture, with subsequent acute retroperitoneal fluid collections, all diagnosed preoperatively on CT scan. The aim of this article is to show the pathways that such collections can take in the retroperitoneum.
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Affiliation(s)
- Rajul Rastogi
- Yash Diagnostic Center, Yash Hospital and Research Center, Civil Lines, Kanth Road, Moradabad, UP - 244 001, India
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Bhattacharjee PK, Choudhury D, Rai H, Ram N, Chattopadhyay D, Roy RP. Spontaneous perforation of common bile duct: a rare complication of choledocholithiasis. Indian J Surg 2009; 71:92-4. [PMID: 23133123 DOI: 10.1007/s12262-009-0024-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Accepted: 08/01/2008] [Indexed: 11/26/2022] Open
Abstract
A 35-year-old female presented with 48 hrs history of severe upper abdominal pain and abdominal distension. The patient was suffering from intermittent episodes of colicky upper abdominal pain and spiky fever with chill and rigor in association with yellowish discoloration of eyes and urine for last 3 months. On examination the lady was dehydrated, icteric, febrile and was having tachycardia and hypotension. Abdominal examination indicated features of generalized peritonitis. Hematological profile suggested neutrophilic leukocytosis, blood biochemistry suggested conjugated hyperbilirubinemia, raised alkaline phosphatase and transaminases. Skiagram of the abdomen showed ground glass opacity without any free gas under the diaphragm. Ultrasonography and contrast enhanced CT scan of the abdomen revealed multiple calculi within a distended, thick walled gall bladder, dilated common bile duct (CBD) with a 12.8 mm stone impacted at its lower end and free fluid in the lesser sac and rest of the peritoneal cavity. Diagnostic abdominal paracentasis showed heavily bile stained fluid. Exploration done for generalized biliary peritonitis with sepsis, revealed erosion at the posterior aspect of the retro-duodenal CBD over the site of the impacted stone. She underwent cholecystectomy, choledocholithotomy through a supra-duodenal choledochotomy, and T-tube drainage of the CBD. She made a slow but steady post operative recovery and was discharged from the hospital after 22 days in favorable conditions.
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Abstract
Spontaneous perforation of the biliary ducts is a rare disorder in infants. Early diagnosis of this entity is important because it can be treated surgically. We report on a 4-month-old child presenting with jaundice and progressive abdominal distention present since birth. Hepatobiliary scintigraphy, which was done to rule out any obstructive pathology, showed a biliary leak from the porta hepatis region leading to biliary ascites and bilateral hydroceles. Surgical exploration and intraoperative cholangiogram confirmed cystic duct perforation. Cholecystectomy and inguinal herniorrhaphy were performed. Follow-up hepatobiliary scintigraphy demonstrated complete resolution of the bile leak and hydroceles.
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Livesey E, Davenport M. Spontaneous perforation of the biliary tract and portal vein thrombosis in infancy. Pediatr Surg Int 2008; 24:357-9. [PMID: 17639421 DOI: 10.1007/s00383-007-1954-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2007] [Indexed: 10/23/2022]
Abstract
Spontaneous biliary perforation (SBP) is an uncommon cause of surgical jaundice in the first few weeks of life and is characterised by the occurrence of a punched-out defect in the bile duct, typically where the cystic duct joins the common hepatic duct. In most cases the site occurs anteriorly and bile leaks into the general peritoneal cavity. We now describe two cases of SBP where the perforation occurred posteriorly, limiting the leak and resulting in delayed recognition. Surgical management in both cases consisted of hepaticojejunostomy-en-Roux. Both cases were complicated, although not immediately, by portal vein thrombosis and one by chylous ascites. Posterior SBP, presumably due to their intimate anatomical relation with the portal vein, seem predisposed to such complications.
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Affiliation(s)
- Emily Livesey
- Department of Paediatric Surgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
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Kanojia RP, Sinha SK, Rawat J, Wakhlu A, Kureel S, Tandon R. Spontaneous biliary perforation in infancy and childhood: clues to diagnosis. Indian J Pediatr 2007; 74:509-10. [PMID: 17526970 DOI: 10.1007/s12098-007-0091-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Spontaneous perforation of extrahepatic bile duct is rare. The cause is idiopathic once trauma and choledochal cyst are ruled out. The condition presents a diagnostic dilemma. Preoperative recognition is necessary as early surgical intervention gives excellent prognosis. We report clinical observations made in three cases with acute presentations. Diagnosis is to be suspected by the presence of jaundice after an initial anicteric period of good health with biliary ascites. This is confirmed by bilious abdominal paracentesis, signs of peritonitis and absent free gas on X ray. The constellation of these three findings was constant in three patients. The presented paper highlights the same as reliable clues to diagnosis.
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Affiliation(s)
- Ravi P Kanojia
- Department of Pediatric Surgery, King George Medical and University (KGMU), Lucknow (UP), 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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36
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Abstract
Generalized biliary peritonitis is a serious intra-abdominal emergency. Most of them occur due to duodenal ulcer perforation and rapidly evolve into bacterial peritonitis due to contamination by gut organisms and food. In this situation, recognition of the pathology and its treatment is straightforward and is usually associated with a good outcome. There are a few unusual causes of biliary peritonitis, of which rupture of the biliary tree is one. We describe a rare case of biliary peritonitis due to rupture of an intra-hepatic biliary radical. Unusual causes of peritonitis do interrupt our daily routine emergency surgical experience. Rapid recognition of the presence of peritonitis, adequate resuscitation, recognition of operative findings, establishment of biliary anatomy, and performance of a meticulous surgical procedure resulted in a good outcome.
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Affiliation(s)
- R Lochan
- Department of Surgery, South Tyneside District General Hospital, South Shields, UK.
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Abstract
Extra-hepatic portal hypertension (EHPH) defined as non cirrhotic, presinusoidal and prehepatic portal hypertension, with obstruction and cavernomatous transformation of the main portal vein, entails a high, early and prolonged risk of gastro-intestinal bleeding (GIB) mainly from esophageal and/or gastric varices, and less often a risk of cholangiopathy or protein-losing enteropathy. Diagnosis of EHPH may be done with non invasive imaging techniques. Assessment of bleeding risk is based on results of endoscopic examination. Occurence of a bleeding episode or onset during follow-up of endoscopic signs of high risk of GIB require radical eradication of varices. Radical cure of EHPH is achieved at best by bypass surgery restoring a physiological portal flow, and as a second choice by shunt surgery. Endoscopic therapy has a place as first line treatment of GIB episodes, and also in a few cases with poor extrahepatic portal network contra-indicating efficient vascular surgery.
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Affiliation(s)
- Frédéric Gauthier
- Service de Chirurgie Pédiatrique, Centre Hospitalier Universitaire Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin Bicêtre, France.
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Davenport M, Betalli P, D'Antiga L, Cheeseman P, Mieli-Vergani G, Howard ER. The spectrum of surgical jaundice in infancy. J Pediatr Surg 2003; 38:1471-9. [PMID: 14577070 DOI: 10.1016/s0022-3468(03)00498-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Conjugated jaundice arising during infancy may be caused by a number of different surgical conditions. The aim of this study was to compare clinical features, management, and outcome of all types of surgical jaundice presenting in the first year of life. METHODS A retrospective review was conducted of all infants born in the United Kingdom with jaundice caused by a surgical cause referred to the authors' institution from January 1992 to December 1999. RESULTS There were 171 infants who could be separated into 3 specific groups: biliary atresia (BA, n = 137), inspissated bile syndrome (IBS; n = 14), and choledochal malformation (CM; n = 12) together with a group containing various miscellaneous conditions (n = 8). Infants with BA had higher bilirubin (P <.01) and aspartate aminotransferase levels (P <.001) and came to surgery earlier (P <.01) than infants with either IBS or CM. Infants with IBS and CM were more likely to be premature and have other malformations, respectively. Ultrasound scan was the principal investigation in the differentiation of BA from other causes of jaundice. Accurate prelaparotomy diagnosis was made by percutaneous liver biopsy in 87% of cases later shown to be BA. Currently, 88 (64%) of children with BA are alive with their native liver postportoenterostomy, 4 have died, and 45 have undergone liver transplantation (with 1 death postoperatively). A policy of primary portoenterostomy for BA followed by transplantation, if necessary, resulted in a survival rate of over 95%. All children in the other diagnostic groups are alive and anicteric after appropriate surgical intervention. CONCLUSIONS Approximately 80% of infants presenting with surgical jaundice have biliary atresia, whereas those with inspissated bile syndrome and choledochal malformations make up most of the remainder. Mortality in this age-group is confined to infants with BA, but even on these infants an overall survival rate of greater than 95% is currently expected.
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Affiliation(s)
- Mark Davenport
- Department of Paediatric Surgery, Kings College Hospital, Denmark Hill, London, England, UK
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Xanthakos SA, Yazigi NA, Ryckman FC, Arkovitz MS. Spontaneous perforation of the bile duct in infancy: a rare but important cause of irritability and abdominal distension. J Pediatr Gastroenterol Nutr 2003; 36:287-91. [PMID: 12548069 DOI: 10.1097/00005176-200302000-00024] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Stavra A Xanthakos
- Division of Pediatric Gastroenterology, Children's Hospital Medical Center, Building C, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA.
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Abstract
BACKGROUND Spontaneous perforation of the bile ducts is a rare condition in adults. It is commonly secondary to gallstones, and the site of the perforation is nearly always extrahepatic. Intrahepatic perforation has only once been described in the literature to date. CASE OUTLINE We report an unusual presentation of this condition with perforation occurring at an intrahepatic site. The management of perforation and the possible predisposing factors are described. DISCUSSION Adequate management of this problem requires an awareness of its existence and prompt, appropriate investigation to discover the cause and site of perforation.
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Affiliation(s)
- F M Ticehurst
- Hepatopancreatobiliary and Transplantation Unit, University College and Royal Free Medical SchoolsLondonUK
| | - R R Hutchins
- Hepatopancreatobiliary and Transplantation Unit, University College and Royal Free Medical SchoolsLondonUK
| | - B R Davidson
- Hepatopancreatobiliary and Transplantation Unit, University College and Royal Free Medical SchoolsLondonUK
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Niedbala A, Lankford A, Boswell WC, Rittmeyer C. Spontaneous Perforation of the Bile Duct. Am Surg 2000. [DOI: 10.1177/000313480006601117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
We present a classic but rare case of spontaneous perforation of the bile duct in infancy and a previously undescribed treatment technique. The patient, a male age 5 weeks, was admitted with abdominal distention, ascites, and conjugated hyperbilirubinemia. Ultrasound revealed ascites but did not provide visualization of the gallbladder. Although hepatobiliary scintigraphy with technetium [dimethyl iminodiacetic acid (HIDA scan)] showed normal uptake peritoneal excretion suggested perforation of the common bile duct (CBD). Exploratory laparotomy revealed 200 cm3 dark amber ascitic fluid in the peritoneal cavity and cholestasis of the liver. Intraoperative cholangiogram performed via the gallbladder showed a large perforation at the cystic duct/CBD junction. The perforation was large and leakage of contrast prevented demonstration of the distal CBD despite our attempt to primarily repair the perforation. The CBD was explored; a T-tube was placed. T-tube cholangiogram demonstrated flow of contrast into the duodenum. A large leak remained at the cystic CBD junction. A cholecystectomy was performed and a vascularized flap of the gallbladder wall was used to repair the CBD over the T-tube. The T-tube was clamped intermittently beginning 3 weeks postoperatively. T-tube cholangiogram performed 6 weeks postoperatively revealed no extravasation and normal intra- and extrahepatic biliary tree. The T-tube was subsequently discontinued and liver function tests remained normal at 6 months follow-up.
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Affiliation(s)
- Angela Niedbala
- Departments of Surgical Education, Memorial Hospital University Medical Center, Savannah, Georgia
| | - Ashley Lankford
- Departments of Surgical Education, Memorial Hospital University Medical Center, Savannah, Georgia
| | - William C. Boswell
- Departments of Surgical Education, Memorial Hospital University Medical Center, Savannah, Georgia
| | - Chris Rittmeyer
- Department of Pediatric Education, Memorial Hospital University Medical Center, Savannah, Georgia
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Affiliation(s)
- M V Suresh-Babu
- Department of Paediatric Gastroenterology, Booth Hall Children's Hospital, Manchester, United Kingdom
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