No abstract

This report describes an 18-month-old boy with a completely isolated duplication cyst (CIDC) of the ileum associated with another classic enteric duplication cyst in the adjacent bowel and presenting as an acute abdomen due to torsion of the pedicle of the CIDC. Cysts excision was curative.

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.Keywords Spontaneous . Common bile duct . Perforation CBD perforation is uncommon, usually reported in infants due to congenital anomalies. Cases have been reported in adults following invasive procedures in and around the CBD. But spontaneous perforation of CBD occurring in an adult presenting as acute abdomen is an unusual phenomenon. We report one such case which presented as acute abdomen exploratory. Laparotomy was done and CBD was found perforated. CBD was explored and closed over the T-tube and the patient recovered uneventfully (Fig. 1). CaseA 44-year-old woman presented with epigastric pain and vomiting of one-day duration. On examination, the abdomen was distended. There was tenderness and guarding in the whole abdomen. On ultrasound examination, there was moderate free fluid in the peritoneal cavity with sluggish peristalsis. Plain radiograph abdomen and chest were normal. Investigations of complete hemogram, blood urea, serum creatinine, and serum electrolytes were within normal limits.The patient was resuscitated and explored. There was bile mixed with peritoneal fluid in the peritoneal cavity. Whole of small and large bowel was explored and was found normal. A perforation was found in the common bile duct (CBD) near the junction of cystic duct and CBD. Cholecystectomy was done and the CBD was explored. There was no calculus, stenosis, or any malformation of CBD. The CBD was closed over a T-tube. Peritoneal lavage was given and abdomen was closed with a subhepatic drain. Bile culture showed Escherichia coli and Widal was also within normal limits. Patient's ELISA for HIV was normal. Investigations for Mycobacterium tuberculosis were negative. The patient had a smooth recovery in the post-operative period. AT-tube cholangiogram was performed on the 12th post-operative day, which was normal. The T-tube was removed on the 14th postoperative day. The patient was discharged after removal of the T-tube. DiscussionSpontaneous CBD perforations are more commonly report...