Spontaneous perforation of the common bile duct in children.

Haller, Jack O.; Condon, Virgil R.; Berdon, W. E.; Oh, Kook Sang; Price, Austin; Bowen, AʼDelbert; Cohen, Harris L.

doi:10.1148/radiology.172.3.2672089

Cited by 59 publications

(34 citation statements)

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“…2 In our patient we report a distinct technetium disofenin imaging pattern of radioactivity leakage into the gallbladder fossa and along the mesenteric folds in the abdomen, caused by the perforated extrahepatic bile duct. The appearance mimicked a peanut shell germinating with roots forming in caudal and transverse directions.…”

Section: Discussionmentioning

confidence: 70%

Imaging Findings of Spontaneous Perforation of Common Bile Duct in an Infant

1998

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A Rifai, SM Shabib, A Al-Rabia, Imaging Findings of Spontaneous Perforation of Common Bile Duct in an Infant. 1998; 18(4): 335-336 Biliary leak can be readily demonstrated with hepatobiliary scintigraphy. Ultrasound and CT can define biliary collections, but cannot easily determine if there is an active leak. We describe a distinctive pattern of spread of the radioactive biliary agent (Tc-disofenin) in the peritoneal cavity, and a secondary reversible parenchymal change in the liver on CT scan, in an infant with a spontaneous rupture of the bile duct. Case ReportAn eleven-month-old infant presented with fever, vomiting and diarrhea. A transient jaundice lasting for four days developed, and was followed by severe abdominal distension associated with whitish stool and drop in weight. There was no history of trauma and the infant had been in good health before this. On physical examination, the infant was mildly distressed. The abdomen was distended with shifting dullness and there was bilateral greenish hydrocele. Urine analysis was normal and the stool was free of bilirubin. Serum bilirubin was 36 mmol/L, alkaline phosphatase 139 units/L, ALT 49 units, total protein 44 g/L, albumin 21 g/L, and PT was 18.4 sec. Diagnostic peritoneal tap revealed 60 WBCs (polymorph. 82%, lymphocytes 16%) and cholesterol 6.8 units. The ascitic fluid bilirubin was 365 mmol/L and the PTT was 58.9 sec. The gram stain and culture of the ascitic fluid were negative and blood culture showed no bacterial growth. Diagnostic Imaging EvaluationUltrasound showed a large amount of free ascites in the abdomen and pelvis, the gallbladder could not be seen, and the liver appeared diffusely echogenic. The CT scan (Figure 1) showed a low-density liver (2 to 12 Hounsfield units), consistent with fatty infiltration. The gallbladder was contracted. The ascitic fluid appeared slightly dense, measuring 15-20 Hounsfield units. Technetium 99m DNA scan using disofenin showed good uptake in the liver, with focal accumulation of radioactivity in the hilum of the liver appearing in a peanut shell-like collection ( Figure 2A). This collection appeared to leak in a branching linear pattern downwards caudally to the right of the midline, and transversely to the left along the mesenteric root and mesocolon boundaries ( Figure 2B). The radioactivity subsequently extended down to the pelvis and ascended to the left side of the abdomen, filling the peritoneal cavity ( Figure 2C).

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Section: Discussionmentioning

confidence: 70%

Imaging Findings of Spontaneous Perforation of Common Bile Duct in an Infant

1998

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“…Distal common bile duct obstruction which was found in some reported cases [3,11,12], including ours in the form of obstructing stone or sludge, has been considered an etiological factor. We, like others, feel [12,13], especially in the absence of common bile duct dilatation, that this is a secondary phenomenon due to bile stagnation in the temporarily dysfunctional common bile duct distal to the perforation rather than the cause of perforation. In these cases, operative cholangiograms may be deceptive suggesting distal common bile duct obstruction as occurred in our case.…”

Section: Discussionmentioning

confidence: 84%

Spontaneous Perforation of the Extrahepatic Bile Ducts–Pathogenesis and Management: Case Report and Review of the Literature

Al-Salem

1992

Ann Saudi Med

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AH Al-Salem, A Al-Faraj, Spontaneous Perforation of the Extrahepatic Bile Ducts-Pathogenesis and Management: Case Report and Review of the Literature. 1992; 12(5): [496][497][498] Spontaneous perforation of the extrahepatic bile ducts is an uncommon condition which occurs almost exclusively during infancy. In 1932 this condition was first reported by Dijkstra [1], who described a small perforation at the junction of the cystic and common bile ducts in an autopsy of a three-month-old infant who died of jaundice and progressive abdominal distention. Since then there have been sporadic case reports from different parts of the world describing this condition [2][3][4]. Occasionally the presentation of spontaneous perforation of the extrahepatic bile ducts is classic, but in the majority the diagnosis is made intraoperatively. This is a case report of spontaneous perforation of the extrahepatic bile ducts and review of the literature, outlining the possible etiological factors and methods of treatment. Case ReportA four-year-old female was admitted to the hospital because of abdominal pain and vomiting of four days' duration. On examination she looked ill, was afebrile and not jaundiced. There was a right-sided tenderness with guarding and rigidity. Bowel sounds were hypoactive. Laboratory investigations showed leukocytosis of 16 × 10 9 /L with 73% polymorphs, 6% bands, 16% lymphocytes and 5% monocytes. Hemoglobin was 11.2 g/dl. Her urine analysis and electrolytes were normal.She was diagnosed as having peritonitis secondary to a perforated appendix. Under general anesthesia, there was a mass in the right lumbar region. Through a right transverse incision at the level of the umbilicus, the peritoneal cavity was opened. There was bile peritonitis and the appendix was found to be normal. There were loculi of bile-stained fluid and further exploration revealed a normal gallbladder and a bile leak at the porta hepatis. Intraoperative cholangiography revealed leak in the common hepatic duct posteriorly above the junction of the cystic and common hepatic ducts (Figure 1). There was also a constant filling defect at the lower end of the common bile duct suggestive of a stone (Figure 1) and the junction of the pancreatic and common bile duct was found to be high (Figure 2), indicating an anomalous arrangement of the pancreaticobiliary system with a long common channel. Cholecystectomy and exploration of the common bile duct were done and after several attempts it was possible to pass a catheter down into the duodenum. A T-tube was inserted and a drain was left in the subhepatic area. Postoperatively, the patient did well and was discharged home on the 14th postoperative day. The T-tube cholangiogram was normal and amylase level from the T-tube on the second and 13th postoperative days showed high levels of 60,640 and 59,000 units respectively, while serum amylase and liver function tests were normal. Seven weeks following her discharge, she was readmitted with mild abdominal pain and vomiting of one days' duration. An intrav...

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“…Etiyolojisinde genitoüri-ner, gastrointestinal, kardiyak, hepatik hastalıklar, TORCH, parvovirüs enfeksiyonları gibi sistemik tutulum yapan enfeksiyonlar, kalıtsal metabolizma hastalıkları olabildiği gibi idiyopatik olarak da gö-rülebilir. [16][17][18] Galaktozemide asit, beslenme sonrası hepatoselüler hasara bağlı olarak genellikle yaşa-mın ikinci haftasından sonra ortaya çıkmaktadır. Ancak, olgumuzda olduğu gibi asit bulgusu bazen yaşamın ilk günlerinde de gelişebilmektedir.…”

Section: Discussionunclassified