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      Spontaneous common bile duct perforation—A rare clinical entity

      case-report

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          Highlights

          • Spontaneous common bile duct perforation is a rare clinical entity.

          • Our case is the first case in the literature of a witnessed spontaneous common bile duct perforation.

          • Our patient was diagnosed prior to surgical intervention, which is unusual with this disease process.

          Abstract

          Introduction

          Spontaneous common bile duct perforation is an uncommon clinical entity in both adults and children. Few case reports have been published since the first clinical description in 1882. Our work has been reported in line with SCARE criteria.

          Presentation of case

          Herein, we describe the case of a 28 year-old female who suffered spontaneous common bile duct perforation while admitted for choledocholithiasis.

          Discussion

          The perforation occurred while in-hospital, and extensive imaging and laboratory tests characterized the disease in detail. To our knowledge, this is the first report of spontaneous common bile duct perforation witnessed from pre-perforation through definitive management.

          Conclusion

          Physicians and Surgeons should seek out this uncommon diagnosis in the patient with suspected Choledocholithiasis who suddenly become peritoneal on physical exam so that definitive care can be expedited.

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          Most cited references11

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          Nontraumatic perforation of the bile duct in adults.

          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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            Spontaneous biliary perforation in infancy: Management strategies and outcomes

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              Spontaneous common bile duct perforation presenting as acute abdomen.

              Spontaneous common bile duct (CBD) perforation is an unusual cause of acute abdomen. It is rarely suspected or correctly diagnosed preoperatively. Clinical presentation is as biliary peritonitis. The common causes are CBD calculus disease, tumors of the bile duct, choledochal cyst and sometimes idiopathic. Treatment is surgical and consists of CBD exploration and repair over a T tube.
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                Author and article information

                Contributors
                Journal
                Int J Surg Case Rep
                Int J Surg Case Rep
                International Journal of Surgery Case Reports
                Elsevier
                2210-2612
                26 March 2018
                2018
                26 March 2018
                : 46
                : 34-37
                Affiliations
                [a ]Department of Surgery, SBH Health System, Bronx, NY, USA
                [b ]Department of Surgery, Montefiore New Rochelle, New Rochelle, NY, USA
                [c ]St. George’s University, Grenada, West Indies
                [d ]New York Institute of Technology College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY, USA
                [e ]Sophie Davis School of Biomedical Education, New York, NY, USA
                Author notes
                [* ]Corresponding author at: Department of Surgery, 4422 Third Ave, Bronx, NY, 10457, USA. mamberger@ 123456sbhny.org
                Article
                S2210-2612(18)30110-X
                10.1016/j.ijscr.2018.03.030
                6000772
                29674006
                aad412c9-4769-4844-9061-41c024891234
                © 2018 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 17 March 2018
                : 22 March 2018
                Categories
                Article

                common bile duct,biliary peritonitis,choledocholithiasis

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