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      Spontaneous common bile duct perforation due to chronic pancreatitis, presenting as a huge cystic retroperitoneal mass: a case report

      case-report
      Author(s): 1 , , 1 , 2
      Publication date (Electronic):
      Journal: Cases Journal
      Publisher: Cases Network Ltd

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          Abstract

          Spontaneous perforation of the bile duct, is a disease in which spontaneous perforation occurs in the wall of the extrahepatic or intrahepatic duct without any traumatic or iatrogenic injury and more often described in neonates. In this report, we present a 38-year-old female patient who underwent surgery due to an intraabdominal cystic mass. The diagnosis of spontaneous rupture of the common bile duct and huge retroperitoneal biloma was made by intraoperative abdominal exploration. The biloma was drained, ruptured portion of the common bile duct was primarily repaired over a T-tube.

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          Nontraumatic perforation of the bile duct in adults.

          Seong-Rok Han, Shin-Wook Kang, Norman Lee … (2004)
          Nontraumatic perforation of the bile duct in adults is rare, and the management of this condition should resolve the primary pathologic lesion. Retrospective analysis of 11 patients who were diagnosed as having nontraumatic perforation of the bile duct. A public university medical center and a private university medical center. Five men and 6 women (median age, 64 years) with nontraumatic perforation of the bile duct were treated between September 1993 and May 2003. Two patients with common bile duct (CBD) stones, who were initially diagnosed as having mediastinal abscess and subcapsular biloma, respectively, were treated by nonoperative management, ie, endoscopic sphincterotomy and percutaneous abscess drainage. The remaining 9 patients were treated surgically, which included an exploration of the CBD, placement of a T tube, and a liver resection. Initial manifestation, primary disease, perforation site, management, surgical morbidity, and mortality. All patients had acute abdominal pain, which was caused by intraabdominal abscess in 7 patients, diffuse bile peritonitis in 3, and subcapsular biloma in 1. Their primary diseases were CBD stones in 7 patients, intrahepatic duct stone in 2, a choledochal cyst in 1, and phytobezoar with food stuff in the CBD in 1. Perforations occurred at the left intrahepatic duct in 9 patients, the CBD in 1, and the cyst wall in 1. All patients recovered, except 1 patient who expired owing to multiorgan failure because the operation could not be performed in time. Nontraumatic perforation of the bile duct should be suspected if perihepatic abscess or peritonitis is combined with biliary stone disease. The management of nontraumatic perforation of the bile duct should include the eradication of the primary pathologic lesion and the control of abscess or peritonitis.
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            Perforation of the gallbladder: a frequently mismanaged condition.

            Ronald Busuttil, J Roslyn (1979)
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              Spontaneous perforation of the biliary tract in infancy: a series of 11 cases.

              B Duquesne, Sylvie Gauthier, Wobbe de Steur … (1996)
              Eleven patients presenting with spontaneous perforation of the biliary tract were treated at Bicêtre Hospital between 1971 and 1993. Three groups were individualised, each with a different pattern of local presentation: generalised biliary peritonitis (n = 2), localised biliary peritonitis (n = 4), secondary biliary stenosis (n = 5). In each case, cholestatic jaundice developed after a postnatal symptom-free interval. Ten patients were operated on. Perforation was located in the cystic duct (n = 2), at the junction of the cystic and hepatic ducts (n = 4), in the common hepatic duct (n = 1) or common bile duct (n = 1). The site of perforation was no longer identifiable in two cases with stenosis. A cholecystectomy was performed in the 2 cases with cystic duct perforation; in the cases of lesions of the main duct, either simple external biliary drainage (n = 3) or biliary reconstruction (n = 5) was carried out. Postoperative complications included bile leak (n = 2), ascending cholangitis (n = 1), portal vein thrombosis (n = 2). Five patients were submitted to further surgery including biliary revision (n = 3), porto-systemic shunt (n = 1), and other procedures (n = 2). One infant died from postoperative sepsis; 2 were lost to follow-up, one of which probably did not survive; 4 are alive and well. Late sequelae are present in 4 children: portal hypertension (n = 1), mild residual bile duct dilatation without cholestasis (n = 1), and mild to moderate liver fibrosis (n = 2). Prompt diagnosis and appropriate treatment should improve the prognosis of this rare condition.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cases J
                Title: Cases Journal
                Publisher: Cases Network Ltd
                ISSN (Electronic): 1757-1626
                Publication date (Electronic): 08 September 2009
                Publication date Collection: 2009
                Volume: 2
                Electronic Location Identifier: 6273
                Affiliations
                [1 ]simpleDepartment of General Surgery, Eskisehir Osmangazi University Faculty of Medicine, Meselik Campus 26480 EskisehirTurkey
                [2 ]simpleDepartment of Radiology, Eskisehir Osmangazi University Faculty of Medicine, Meselik Campus 26480 EskisehirTurkey
                Article
                Publisher ID: 6273
                DOI: 10.4076/1757-1626-2-6273
                PMC ID: 2769279
                PubMed ID: 19918569
                SO-VID: 103a2713-d01b-40f7-80ea-63ff63cc20c3
                Copyright © © 2009 Yaşar et al.; licensee Cases Network Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 01 March 2009
                Date accepted : 28 July 2009
                Categories
                Subject: Case report

                ScienceOpen disciplines: Medicine
                Data availability:
                ScienceOpen disciplines: Medicine

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