Spontaneous perforation of the extrahepatic bile duct in an infant

Abstract

A 1.2-year-old male presented with gradual-onset biliary ascites, mild icterus, and failure to thrive due to spontaneous bile-duct perforation (SPBD) confirmed by technetium 99Tc HIDA scan and abdominal paracentesis. Peritoneal tube drainage for 2 weeks helped the perforation to seal spontaneously, as there was no distal obstruction. No surgery was needed. Only less than 100 cases of SPBD have been reported in the English literature. The pathogenesis and treatment options are reviewed and discussed.

Spontaneous biliary peritonitis, or delayed bile leak?

“…Duct malformation has been hypothesised as being responsible for extrahepatic duct perforation in neonatal cases. 3 Ductal structures may also be damaged at operation or during trauma. In this case for example, anomalous radical ducts may have been traumatised during cholecystectomy.…”

“…[1][2][3][4][5][6][7][8] Whilst usually of extrahepatic origin, here we describe perforation of an intrahepatic duct.…”

Spontaneous perforation of the bile duct in a neonate: Drainage or resection?

“…Drainage often leads to spontaneous closure of a perforated bile duct, but surgical treatment should be individualized. 1,3,4 Bile duct stenosis is the most common complication after simple drainage and may progress to biliary cirrhosis and portal hypertension. Intraoperative cholangiography is necessary to confirm the potential anatomical anomaly or distal obstruction.…”

“…1e3 The etiology is unknown, but there are many possible causes, such as congenital mural weakness of the common bile duct, relative ischemia of its anterior wall due to posterolateral arterial supply of the bile duct, and anatomic anomalies (such as cyst, diverticulum, and distal biliary obstruction). 2,4 Diagnosis is usually confirmed with surgical exploration, and good prognosis depends on early surgical intervention. 1,2 We report on a 10-day-old female neonate with spontaneous perforation and nearly total transection of the bile duct at the junction of the cystic duct and common hepatic duct, whose condition was managed by cholecystectomy and biliary reconstruction.…”

Spontaneous gallbladder perforation in a neonate

“…There are numerous reports of spontaneous perforations of the extrahepatic biliary tree in the literature, but perforation of the gallbladder in children is very rare [1][2][3][4][5]. The usual presentation is gradual onset of jaundice and abdominal distension (due to biliary ascites) in a previously well child.…”