Spontaneous common bile duct perforation in adult: a case report and review

Common bile duct perforation has been reported in adults after invasive procedures. Spontaneous common bile duct perforation is a rare entity as a cause of acute abdomen in adults. A few cases due to choledocholithiasis have been reported as a cause of spontaneous perforation. We report an adult patient who presented with acute abdomen after spontaneous common bile duct perforation due to unknown etiology who was treated successfully.     

Spontaneous perforation of the common bile duct: report of a case.

A case is reported of spontaneous perforation of the common bile duct in a 59-year-old woman. Recurrent episodes of epigastric and right hypochondriac pain over one year culminated in the onset of obstructive jaundice. There were not signs of peritonitis, and laparotomy revealed an abscess surrounding a perforation in the common bile duct just distal to the cystic duct. A cholesterol gallstone was present at the site of perforation. A paracolon bacterium, providence alcalifaciens, was isolated from the abscess. The patient made an uncomplicated recovery after cholecystectomy and drainage of the bile duct.     

Bile peritonitis due to a spontaneous perforation of the common bile duct: Report of a case

Spontaneous perforation of the extrahepatic bile duct is rare. We herein report the case of an 80-year-old woman who underwent emergency laparotomy for bile peritonitis due to a spontaneous perforation of the common bile duct. A 2-mm perforation was found in the posterior wall of the choledochus, and its wall was paper-thin. Three stones, 2 mm in diameter, were removed from the common bile duct. She underwent T-tube decompression with intraoperative cholangiography demonstrating a swollen papilla of Vater. The swelling of the papilla disappeared 4 weeks after the operation. Her postoperative course was uneventful. It seems likely that the elevated intraductal pressure due to the swollen papilla following stone impaction caused the perforation in this patient. Furthermore, the excessive friability of the common bile duct of unknown etiology may also have contributed to the perforation. This experience along with a review of the literature indicate that biliary decompression is the treatment of choice for this condition.     

小儿特发性胆总管穿孔1例

患儿　女 ,6岁。 4 5ｈ前进食约半斤沙果后觉上腹痛 ,腹胀伴恶心 ,呕吐进行性加重入院。体查 :痛苦面容 ,皮肤无黄染 ,腹微膨隆。右侧腹部轻度压痛 ,无肌紧张及反　　 收稿日期 :2 0 0 0 0 4 10。　　 作者简介 :严天卿 ( 1968 ) ,男 ,内蒙古自治区乌兰浩特人 ,内蒙古自治区兴安盟人民医院主治医师 ,主要从事肝胆外科研究。跳痛 ,未叩及移动性浊音 ,肠鸣音减弱。血尿常规、血尿淀粉酶均未见异常。入院后立即给予禁食 ,抗炎补液等对症治疗。入院后 8ｈ ,患儿右侧腹部压痛加重 ,伴反跳痛及肌紧张 ,肠鸣音未闻及。Ｂ超检查 ,肝、胆、脾、胰腺…     

Spontaneous bile duct perforation in an infant. A case report

A case of spontaneous perforation of the common bile duct in a 4-month-old girl is described. Perforation of the biliary tract is rare, but must be suspected in a child with pale stools, minimal or no jaundice and biliary ascites. Treatment is surgical. Patency of the distal biliary tract must be demonstrated by intra-operative cholecystocholangiography; drainage without repair of the perforation is then appropriate. If there is distal biliary tract obstruction, a biliary-intestinal anastomosis is needed. The difficulty of diagnosis is highlighted by the time between presentation and operation reported in many published cases; suggestions are made to aid a more rapid diagnosis.     

Intestinal perforation due to phytobezoar obstruction: a case report

Phytobezoars are uncommon causes of acute abdomen. We report a patient who presented with acute abdomen and who was intra-operatively diagnosed as having a small intestinal perforation due to an intestinal phytobezoar.     

Common bile duct polyp mimicking choledocholithiasis: a case report with laparoscopic transcystic management

Although polyps of the extrahepatic biliary system are rare, an awareness of their potential existence is important as they may closely mimic choledocholithiasis clinically and radiologically but require distinct measures for successful management. This report describes the presentation and successful laparoscopic transcystic management of this infrequently encountered condition. It also explores the literature and discovers the numerous potential presenting features of common bile duct calculi and the spectrum of possible management options.     

Common bile duct adenoma: case report and brief review of literature

Papillary adenomas of the common bile duct are a rare entity with few published case reports and limited knowledge on its natural progression. We report here a case of common bile duct papillary adenoma in a 69-year-old female who presented with symptoms of common bile duct obstruction. She was treated with local endoscopic excision of the mass that has benign features. A brief review of literature is discussed with a proposed treatment plan for follow-up with surveillance endoscopy and ultrasonography as opposed to the radical resection for benign findings on pathology.     

Sealed-off spontaneous perforation of the common bile duct. A case report

A case of spontaneous perforation of the common bile duct is reported, in which there was no bile peritonitis or bile collection. The mechanism of sealed-off perforation of the duct is discussed. Cholecystectomy and T-tube decompression of the common bile duct were performed after exploration.     

Intestinal perforation due to multiple magnet ingestion: a case report

Multiple magnet ingestion during childhood may result in emergency situations. A single magnet may be discharged with intestinal peristalsis, but multiple magnets may stick together and cause significant intestinal complications. Here we present a case with intestinal perforation due to ingestion of multiple magnets and metal pieces. An eight-year-old girl presented with abdominal pain and vomiting. She had abdominal tenderness and defense on the physical examination. Abdominal X-ray showed air and fluid levels. Metallic images were not considered at first as important in the diagnosis. Abdominal ultrasonography was reported as acute appendicitis. During the abdominal exploration, the appendix was normal, but there were dense adherences around the ileum and cecum. After adhesiolysis, intestinal perforations were seen in the cecum and 15 and 45 cm proximal to the cecum. Magnet and metal pieces were present in the perforated segments. Wedge resection and primary repair was performed. There were no postoperative complications, and she was discharged on the postoperative fifth day. Pediatric surgeons should be aware of the complications of multiple magnet ingestion. If the patient has a history of multiple magnet ingestion, follow-up with daily abdominal X-rays should be done, and in cases where magnets seem to cluster together or if acute abdominal signs develop, surgical exploration should be considered.     

先天性婴儿型胆管纤维肉瘤一例

1 临床资料 患儿女,4岁.因全身皮肤及巩膜进行性黄染15 d,腹痛4d于2010年4月22日入院.患儿4月7日前无明显诱因出现全身皮肤及巩膜黄染,呈进行性加重,伴有小便颜色加深呈浓茶色及全身皮肤瘙痒,无畏寒、发热、恶心、呕吐、腹胀、腹痛等不适.于当地医院输液治疗(具体用药不详),患儿症状无明显缓解.4月18日患儿出现腹部隐痛,伴有腹胀、厌油、恶心、呕吐,为求进一步诊断和治疗收入我科.入院体格检查:患儿发育正常,营养中等,全身皮肤及巩膜中度黄染.腹部稍膨隆,腹软,右季肋区深压痛,无反跳痛及肌紧张.右肋缘下约3 cm可触及肝脏,表面光滑,右季肋区可同时扪及肿大胆囊,张力高,余腹未扪及明显包块.     

Common bile duct MALT lymphoma: case report and review of the literature

We report a rare case of common bile duct mucosa-associated lymphoid tissue (MALT) lymphoma treated with pancreatico-duodenectomy with a partial gastrectomy. MALT lymphoma involving the biliary tree is extremely rare. Diagnosis is difficult and treatment options are controversial. Even though Helicobacter pylori treatment is effective in the early stages of the disease, surgery is still helpful especially when obstruction, perforation, or bleeding is present.     

Conservative management of spontaneous bile duct perforation in infancy:: case report and literature review

Spontaneous bile duct perforation in infants is rare, with less than 150 cases having been reported worldwide. With a highly variable presentation, diagnosis and treatment can prove challenging, and outcomes are not without significant morbidity. We herewith report the case of an 8-week-old male infant with spontaneous bile duct perforation. He initially presented with abdominal sepsis and septated ascites on ultrasound, which was confirmed as bilious on ascitic tap and at diagnostic laparoscopy. Intraoperative cholangiogram demonstrated a localized leak at the junction of the cystic and common bile duct. Conversion to laparotomy was ultimately required with cholecystostomy, and 2 external intraabdominal drains were placed. He was subsequently managed conservatively with 4 weeks external drainage, with a repeat cholangiogram at 6 weeks, demonstrating successful resolution of the leak. The reported case supports the findings of changing practices in the existing literature. We suggest that, in cases of spontaneous bile duct perforation with no distal obstruction, dissection and surgery to the biliary tree are not always required. Conservative management with simple external drainage can have its complications but, as shown here, can be a successful treatment option in terms of healing of perforation.     

胆总管隔膜致胆管炎反复发作一例

病人,男,77岁.7年来反复右上腹疼痛,每次均伴恶寒、发热及黄疸,多次B超、CT检查均报告"胆囊肿大,肝内外胆管扩张",未见结石及其他占位病变.     

Massive bile pertonitis in infancy due to spontaneous bile duct perforation with portal vein occlusion.

A case of massive bile peritonitis due to spontaneous slough of the junction of the cystic, common, and common hepatic ducts in a 5-wk-old male infant is reported. This was managed successfully by a Roux-en-Y jejunal anastomosis to the remnant of common hepatic duct. Subsequent ascites (4 mo postoperatively) was relieved by peritoneovenous drainage by a Holter valve from the peritoneal cavity to the right atrium. Comments are made relative to an etiologic commonality between spontaneous perforation of the bile ducts in infancy, “congenital” choledochal cyst, and biliary atresia and a possible role for birth-acquired viral infection, particularly with a herpes type of virus, in these disorders.