Spontaneous perforation of the common bile duct in adults presenting as biliary peritonitis: a case report and literature review

Abstract

Introduction: Spontaneous perforation of the common bile duct (SPCBD) is an exceptional disease, especially in adults. The cause is often idiopathic once trauma and choledochal cyst are excluded. Early diagnosis is often difficult because of its often-misleading appearance. Case presentation: The authors report the case of a 54-year-old man, a known case of type 2 diabetes mellitus, who presented to our emergency department for acute abdominal pain that had evolved for 2 days. Clinical findings and investigations: On physical examination, the patient had a fever of up to 38.5°C, and the abdomen was distended and generally tight. The abdominal computerized tomography scan confirms the presence of free fluid. In addition, the thickness of the gallbladder wall had increased in contrast with a resolved gallbladder distention. Because exploration failed to demonstrate the cause of ascites, the authors performed a diagnostic paracentesis, which revealing ascites with a dark yellow-green color, which implied bile leakage. After initial resuscitation, an emergent exploratory laparotomy was performed. The authors found biliary peritonitis secondary to SPCBD. After peritoneal lavage, the perforation was repaired over a T-tube. The postoperative course was uneventful. Histological findings were consistent with ulcerous acalculous cholecystitis. The patient was disease-free after a 3-month follow-up. Discussion: SPCBD is an uncommon condition in adults, and it is rarely reported in the literature. The pathogenesis of this disease is not clear and may be related to single or multiple factors. Usually, this disease is diagnosed in the postmortem. Early diagnosis and optimal surgical treatment are challenging. Conclusion: This present case highlighted the preoperative diagnostic difficulties of the SPCBD. Emergent surgical management should be instituted in the shortest time possible to reduce the high mortality.

Spontaneous common bile duct perforation: a rare case report

“…The surgical approach can be either laparoscopic or open, depending on the severity of the conditions and the patient's overall health status. 8 The goal of surgery to remove the underlying cause of perforation, such as gallstones or other biliary obstruction and repair of the perforation site. With advancement in surgical techniques, minimal invasive surgery through the laparoscopic approach used for diagnostic and therapeutic purposes for CBD perforation.…”

Uroperitoneum as an Atypical Source of Ascites: A Case Report

“…While there is minimal literature documenting the appearance of ascitic fluid in cases of uroperitoneum, there are known associations between the appearance of ascitic fluid and other diagnoses. For example, ascitic fluid with a dark yellow-green color is associated with bile leakage [ 6 ]. Turbid ascitic fluid is associated with spontaneous bacterial peritonitis and chylous ascites and has been shown to have a 46.9% sensitivity and 87.4% specificity for the diagnosis of spontaneous bacterial peritonitis [ 7 , 8 ].…”

Choledocholithiasis as a Cause of Spontaneous Common Bile Duct Perforation: From Myths to Reality. A Case Report

“…After this rst report, only a few cases have been reported due to its low incidence. Most cases have been described in children due to congenital anomalies of the biliopancreatic system 2,4 . In the general adult population, it is extremely rare.…”

“…In general, the presurgical diagnosis of a spontaneous CBD perforation is particularly challenging and is usually made during surgery because patients present with a variety of signs and symptoms that are not speci c or suggest other more common entities. 4 . This happened in our case, where the rst presumptive diagnosis was acute appendicitis, and even with the presence of biliary uid in the abdominal cavity, CBD perforation was not suspected.…”

“…In most cases, the perforation is rst evident during an exploratory laparotomy, posing a challenge on treatment due to the lack of presurgical planning. 4 .…”