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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

Postoperative T-tube cholangiogram showing biliary anatomy and contrast leak.
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fig2: Postoperative T-tube cholangiogram showing biliary anatomy and contrast leak.

Mentions: The patient made a slow postoperative recovery. There was persistent drainage of bile through the subhepatic drain until the 10th postoperative day. T-tube cholangiogram performed on the 10th postoperative day showed leaking and the pooling of contrast at T-tube insertion site of CBD with leaking tract extending towards drain site (Figure 2). It also showed that there was a filling defect in the distal CBD with contrast flow into the duodenum. Therefore, subsequently she underwent endoscopic retrograde cholangiopancreatography and extraction of distal CBD stone. T-tube was removed on the 30th postoperative day and she was discharged on 35th postoperative day. She was doing well at the time of the first visit and on follow-up visits until 1 year.


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)

Postoperative T-tube cholangiogram showing biliary anatomy and contrast leak.
© Copyright Policy
Related In: Results  -  Collection

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

fig2: Postoperative T-tube cholangiogram showing biliary anatomy and contrast leak.
Mentions: The patient made a slow postoperative recovery. There was persistent drainage of bile through the subhepatic drain until the 10th postoperative day. T-tube cholangiogram performed on the 10th postoperative day showed leaking and the pooling of contrast at T-tube insertion site of CBD with leaking tract extending towards drain site (Figure 2). It also showed that there was a filling defect in the distal CBD with contrast flow into the duodenum. Therefore, subsequently she underwent endoscopic retrograde cholangiopancreatography and extraction of distal CBD stone. T-tube was removed on the 30th postoperative day and she was discharged on 35th postoperative day. She was doing well at the time of the first visit and on follow-up visits until 1 year.

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