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Spontaneous Perforation of Common Bile Duct: A Rare Presentation of Gall Stones Disease.

Subasinghe D, Udayakumara EA, Somathilaka U, Huruggamuwa M - Case Rep Gastrointest Med (2016)

Bottom Line: Case Presentation.Conclusion.Therefore, awareness of the clinical presentation, expert ultrasound examination, and surgery are important aspects in the management.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, General Hospital, 60000 Kurunegala, Sri Lanka.

ABSTRACT
Background. Spontaneous perforation of the extrahepatic biliary system is a rare presentation of gall stones. Very few cases of bile duct perforation have been reported in adults. It is rarely suspected or correctly diagnosed preoperatively. Case Presentation. A 66-year-old female presented at the surgical emergency with 3 days' history of severe upper abdominal pain with distension and repeated episodes of vomiting, as she had evidence of generalized peritonitis and underwent an exploratory laparotomy. A single 0.5 cm × 0.5 cm free perforation was present on the anterolateral surface of the common bile duct at the junction of cystic duct. A cholecystectomy and the CBD exploration were performed. Conclusion. Spontaneous perforation of the extrahepatic bile duct is a rare but important presentation of gall stones in adults. Therefore, awareness of the clinical presentation, expert ultrasound examination, and surgery are important aspects in the management.

No MeSH data available.


Related in: MedlinePlus

Perforation on the anterolateral surface of the common bile duct.
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fig1: Perforation on the anterolateral surface of the common bile duct.

Mentions: Operative findings included bilious peritoneal fluid in dependent parts of the peritoneal cavity with localized collection of bile inside the lesser sac. Gall bladder was distended with thickened wall and contained multiple stones. A single 0.5 cm × 0.5 cm free perforation was present on the anterolateral surface of the common bile duct at the junction of cystic duct (Figure 1). The common bill duct was dilated and contained multiple stones. A cholecystectomy was done and the CBD was explored. Multiple small stones were removed, irrigation was done with warm normal saline, and the CBD was closed over a T-tube inserted through the site of perforation. The peritoneal cavity was thoroughly irrigated with warm normal saline. The abdomen was closed after inserting a suction drain in the hepatorenal space. Unhealthy edges of the perforation site were excised and sent for the histology which subsequently showed inflamed necrotic tissue without any evidence of malignant cells. The histology of the gallbladder was suggestive of chronic cholecystitis.


Spontaneous Perforation of Common Bile Duct: A Rare Presentation of Gall Stones Disease.

Subasinghe D, Udayakumara EA, Somathilaka U, Huruggamuwa M - Case Rep Gastrointest Med (2016)

Perforation on the anterolateral surface of the common bile duct.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940531&req=5

fig1: Perforation on the anterolateral surface of the common bile duct.
Mentions: Operative findings included bilious peritoneal fluid in dependent parts of the peritoneal cavity with localized collection of bile inside the lesser sac. Gall bladder was distended with thickened wall and contained multiple stones. A single 0.5 cm × 0.5 cm free perforation was present on the anterolateral surface of the common bile duct at the junction of cystic duct (Figure 1). The common bill duct was dilated and contained multiple stones. A cholecystectomy was done and the CBD was explored. Multiple small stones were removed, irrigation was done with warm normal saline, and the CBD was closed over a T-tube inserted through the site of perforation. The peritoneal cavity was thoroughly irrigated with warm normal saline. The abdomen was closed after inserting a suction drain in the hepatorenal space. Unhealthy edges of the perforation site were excised and sent for the histology which subsequently showed inflamed necrotic tissue without any evidence of malignant cells. The histology of the gallbladder was suggestive of chronic cholecystitis.

Bottom Line: Case Presentation.Conclusion.Therefore, awareness of the clinical presentation, expert ultrasound examination, and surgery are important aspects in the management.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, General Hospital, 60000 Kurunegala, Sri Lanka.

ABSTRACT
Background. Spontaneous perforation of the extrahepatic biliary system is a rare presentation of gall stones. Very few cases of bile duct perforation have been reported in adults. It is rarely suspected or correctly diagnosed preoperatively. Case Presentation. A 66-year-old female presented at the surgical emergency with 3 days' history of severe upper abdominal pain with distension and repeated episodes of vomiting, as she had evidence of generalized peritonitis and underwent an exploratory laparotomy. A single 0.5 cm × 0.5 cm free perforation was present on the anterolateral surface of the common bile duct at the junction of cystic duct. A cholecystectomy and the CBD exploration were performed. Conclusion. Spontaneous perforation of the extrahepatic bile duct is a rare but important presentation of gall stones in adults. Therefore, awareness of the clinical presentation, expert ultrasound examination, and surgery are important aspects in the management.

No MeSH data available.


Related in: MedlinePlus