Spontaneous common bile duct perforation in full term pregnancy: a rare case report and review of literature

Abstract

Background Spontaneous biliary system perforation is a rare presentation in clinical practice especially in adults. It is rarely suspected and diagnosed preoperatively due to small number of cases, vague sign and symptoms, and ambiguous presentation. Case presentation We describe an interesting case of spontaneous perforation of the common bile duct in a 16 year-old female who presented a week after her first birth to the emergency department with complaints of diffuse abdominal pain, abdominal distention, fever, vomiting, and constipation. She was having generalized peritonitis but the etiology was unclear despite a thorough workup. She underwent exploratory laparotomy, and a perforation in the supra duodenal region of the common bile duct was found intraoperatively. The common bile duct was repaired over T-tube, and cholecystectomy was performed; the patient was recovered uneventfully. Conclusion Spontaneous biliary perforation is a rare cause of acute abdomen in adults and extremely rare in pregnancy. Its delayed diagnoses and management can lead to a high morbidity and mortality. All physicians, especially surgeons, should be aware of this possibility and consider it a cause of peritonitis on differential diagnosis particularly when there is no apparent etiology available for presentation.

Spontaneous perforation in the bile duct system

“…Большинство перфораций желчных протоков связано с ятрогенной травмой, допущенной при холецистэктомии, эндоскопической ретроградной холангиопанкреатикографии (ЭРХПГ) [1]. Также известно о нетравматических, или спонтанных, перфорациях желчных протоков.…”

“…У взрослых это состояние выявляют значительно реже. Несмотря на то что первое сообщение о нетравматической перфорации общего желчного протока (ОЖП) опубликовано в 1882 г., судить о распространенности этого явления не просто [1]. В наибольшем одноцентровом ретроспективном исследовании, в котором отражен 10-летний опыт лечения пациентов с заболеваниями печени, частота нетравматических разрывов желчных протоков составила 0,32% -11 из 3464 наблюдений [3].…”

In correspondence to “Spontaneous common bile duct perforation in full term pregnancy: a rare case report and review of literature”

“…With great attention and interest, I read the case report by Masroor and Sarwari [ 1 ]. They aimed to present an extremely rare case of spontaneous common bile duct (CBD) perforation during pregnancy.…”

Analysis of the Clinical Characteristics of Spontaneous Bile Duct Perforation in Children

“…Spontaneous bile duct perforation (SBDP) is a rare disease, mostly affecting children about 6 months of age, with the age at onset ranging from 25 weeks of gestation to 7 years after birth ( 1 – 3 ). The most common presentation of SBDP is abdominal distension, ascites, and jaundice; other symptoms may include localized or generalized peritonitis, pyrexia, and septic shock with or without signs and symptoms of a biliary tract disease ( 2 , 4 , 5 ).…”