Spontaneous Biliary Perforations: An Uncommon yet Important Entity in Children

Abstract

Spontaneous or idiopathic biliary perforations are an infrequently encountered but an important cause of surgical jaundice in paediatric patients and one of the most common causes of surgical jaundice in infancy. A pre-operative diagnosis with a clinical history and physical findings may not be possible in most of the cases. The exact cause of the perforation remains unclear and the diagnosis is made at the time of laparotomy for an acute abdomen. An early, efficient and an effective surgical management is associated with a good prognosis; however, a delay in the correct diagnosis or an inappropriate management may result in bacterial contamination of the biliary ascites, with an unfavourable outcome. The relative rarity of this condition is reflected by the very few case reports, limited case studies and scarcity of published literature.

Congenital choledochal malformations in children: management strategies

“…Perforation of the common bile duct may occur due to the abrupt increase in intraluminal pressure due to obstruction by protein plugs at the common channel that results in decreased blood flow in the vessels which run along the lateral border of the bile ducts resulting in ischemia on the anterior surface of the bile duct. 14 The onset of symptoms in our cases were acute in one cases and subacute in rest of three cases. In acute forms child presented with vomiting, severe abdominal pain and shock.…”

Perforación espontánea de la vía biliar en un neonato: un hallazgo inesperado. Caso clínico

“…Las pruebas de laboratorio no son patognomóni-cas, usualmente revelan ictericia colestásica y elevación de la fosfatasa alcalina, las otras pruebas de función hepática usualmente son normales 15 . Las imágenes pueden ser de ayuda para evaluar el estado de gravedad.…”

“…La radiografía de abdomen puede demostrar neumoperitoneo o hallazgos sugestivos de ascitis. El ultrasonido de abdomen aporta datos adicionales como la dilatación de los conductos extrahepáticos, los conductos intrahepáticos suelen estar normales 4,15 . Otros exámenes complementarios, serían la gammagrafía hepatobiliar, la cual es altamente sensible y específica, pudiendo demostrar que el líquido intraperitoneal se origina a partir de la vía biliar 16 y la colangiopancreatografía por resonancia magnética, la cual ha sido utilizada para identificar la perforación del conducto biliar, así como para demostrar anomalías anatómicas 17 .…”

Endoscopic biliary drainage as a bridging procedure to single-stage surgery for perforated choledochal cyst: a case report and review of the literature

“…Perforation of CC is a rare, but important, condition in children [ 25 , 26 ]. Spontaneous perforation of CC in adults is extremely rare [ 6 , 7 ].…”