Biliary Peritonitis due to Spontaneous Perforation of Choledochus: A Case Report

Abstract

Spontaneous perforation of common bile duct (CBD) in an adult is an exceedingly rare phenomenon. It is mostly seen in infants due to congenital anomalies. The diagnosis of biliary tract perforations is often delayed due to their nonspecific symptoms, which results in high morbidity. Early diagnosis and aggressive therapy are mandatory to alleviate this condition. Delayed diagnoses and treatment may have more serious consequences in terms of morbidity as well as mortality. We herein report spontaneous perforation of CBD in a middle-aged male who presented to our accident and emergency department with acute abdominal pain. Exploratory laparotomy revealed a small perforation with necrosed margins in the supraduodenal part of CBD, which was managed by a T-tube drain. However, no apparent cause for the perforation was found.

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

“…25 The junction of the cystic and hepatic ducts was reported as the most common site of perforation. 6,[26][27][28] Other sites include cystic duct, common hepatic duct, and common bile duct. However, in our present case the perforation occurred in the left intrahepatic bile duct, near the left triangular ligament.…”

Acute Abdomen Secondary to a Spontaneous Perforation of the Biliary Tract, a Rare Complication of Choledocholithiasis

“…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 [5] . The gall bladder, common bile duct, common hepatic duct and anomalous ducts of the liver are specific sites of biliary compromise; in most of the cases they are extrahepatic and are found frequently at the junction of the cyst duct and the common bile duct [6] , [9] . In our case, the leak was located in the middle third of the common bile duct.…”

“…In most of the cases, the encapsulation of the bile within the omentum and mesentery prevents generalized peritonitis, forming bilomas; which are generally localized in the right upper quadrant of the abdomen. As the bile is sterile and is absorbed by the peritoneum, the patients may not present symptoms for weeks, until the bile becomes superinfected [10] , [18] .Thus the diagnosis of biliary tract perforation is often delayed, which results in high morbidity [6] .…”

“…The spontaneous perforation of the biliary tract (SPBT) is an extremely rare cause of peritonitis [4] , [5] , [6] , [7] , which was first described by Freeland in 1982, to date only around 70 cases have been reported [5] , [6] , [7] .…”

“…Since the symptoms and signs are not specific, the diagnosis is often delayed. So that, in most of the cases the diagnosis is made upon surgery [6] , [10] , [11] , [12] . 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.…”