Biliary peritonitis secondary to perforation of common bile duct: an unusual presentation of chronic calcific pancreatitis

An Unusual Cause of Biliary Peritonitis on the Background of Acute Pancreatitis: A Case Report

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.

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

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

T tube drainage for spontaneous perforation of the extrahepatic bile duct

Background

Spontaneous perforation of the extrahepatic bile duct is very rare. We report a patient with a spontaneous perforation of the left hepatic bile duct who was diagnosed preoperatively.

Case Report

A 65-year-old woman was admitted to our hospital complaining of a right upper quadrant pain lasting for two days. She was diagnosed as having a perforated bile duct and peritonitis and underwent a laparotomy. After a cholecystectomy, T-tube drainage of the left hepatic duct was performed. The postoperative course was uneventful. The T tube was removed 25 days after the surgery.

Conclusions

A more noninvasive procedure, such as endoscopic treatment, should play a central role in the management of extra bile duct perforation. For this case, however, we chose to perform a laparotomy based on the patient’s general condition and the presence of peritonitis. T tube decompression is effective and a safe and reliable method. The goal of treatment is to stop the bile leakage, resolve the choledocholithiasis and cholangitis, and reconstruct the bile duct.

Bile peritonitis due to a spontaneous perforation of the common bile duct: report of a case

Spontaneous perforation of the extrahepatic bile duct is rare. We herein report the case of an 80-year-old woman who underwent emergency laparotomy for bile peritonitis due to a spontaneous perforation of the common bile duct. A 2-mm perforation was found in the posterior wall of the choledochus, and its wall was paper-thin. Three stones, 2mm in diameter, were removed from the common bile duct. She underwent T-tube decompression with intraoperative cholangiography demonstrating a swollen papilla of Vater. The swelling of the papilla disappeared 4 weeks after the operation. Her postoperative course was uneventful. It seems likely that the elevated intraductal pressure due to the swollen papilla following stone impaction caused the perforation in this patient. Furthermore, the excessive friability of the common bile duct of unknown etiology may also have contributed to the perforation. This experience along with a review of the literature indicate that biliary decompression is the treatment of choice for this condition.