2011, Number 2
Acta Pediatr Mex 2011; 32 (2)
Spontaneous bile duct perforation. Report of a case in an infant
Alonso-Hernández MA, Ávila-Zaragoza LM, Jiménez-Urueta PS, Castañeda-Ortiz RA, Gutiérrez-Escobedo J
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Biliary ascitis is usually the result of a spontaneous or a traumatic perforation of the common bile duct (CBD); it occurs usually at the junction with the cystic duct. Distal duct obstruction, pancreatic fluid reflux in the common bile duct, congenital weakness or a localized mural malformation of the wall of the common duct have been proposed as possible causes for this event. We present a case of bile duct perforation in child and discuss the etiopathogenesis and management In the light of available literature.
We present the case of a two year old girl who developed biliary ascitis following a biliary duct rupture. She was admitted after the spontaneous onset of increasing abdominal pain associated with vomiting and fever. Shock ensued rapidly; an emergency laparotomy was performed. After aspirating 200 mL of bile-stained fluid from the peritoneal cavity, a small perforation was found in the anterior wall of the moderately dilated CBD. A T tube was placed for drainage of the area and a cholecystectomy was performed.
The pathogenesis of a perforation of the common bile duct (PCBD) is not known, although presumably there is an acute rise in pressure caused by a distal obstruction which results in perforation. T-tube is the preferred treatment for anterior perforations. Simple drainage with or without suture closure, is the conservative treatment; T-tube and cholecystostomy has been proposed as the treatment of choice.
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