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Spontaneous perforation of common bile duct in infants
Insights
Spontaneous perforation of the common bile duct in infants is rare. Early diagnosis and surgical correction, such as cholecystenterostomy, are crucial for rapid recovery.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatal Care
Background:
- Spontaneous perforation of the common bile duct (CPD) is a rare cause of neonatal jaundice.
- Diagnosis is often delayed due to non-specific symptoms.
Observation:
- Two infants presented with jaundice, acholic stools, and ascites.
- Bile-stained ascites and scrotal bile staining were key diagnostic indicators.
- 131I-Rose Bengal excretion tests confirmed impaired bile flow.
Findings:
- Operative cholangiography revealed perforation at the cystic duct-common bile duct junction.
- No contrast entered the duodenum, indicating complete obstruction.
- Cholecystenterostomy with a Roux-en-Y jejunal loop was performed.
Implications:
- Cholecystenterostomy is an effective treatment for spontaneous common bile duct perforation.
- This condition must be considered in the differential diagnosis of infantile obstructive jaundice.
- Prompt surgical intervention is necessary for favorable outcomes.
Abstract:
Two infants with spontaneous perforation of the common bile duct are described. One presented with mild jaundice, dark urine, acholic stools, and hydroceles, the other with bilateral inguinal hernia. In both the diagnosis was unsuspected until bile-stained ascites was discovered. Both eventually developed bile-staining of the scrotum. Neither was acutely ill. The 131I-Rose Bengal faecal excretion test showed reduced faecal excretion at 8% and 12% of the injected dose with 16-5 and 17%/dl of the dose being recovered in the ascitic fluid 48 hours after intravenous injection. The ascitic:plasma ratio of isotope at that time was 32:1 and 28:1. Operative cholangiography in both showed a perforation at the junction of the cystic duct and common bile duct with no contrast entering the duodenum. Cholecystenterostomy using a Roux-en-Y loop of jejunum produced a rapid sustained recovery and is suggested as the treatment of choice. This condition should be considered in the differential diagnosis of obstructive jaundice in infancy since early surgical correction is necessary.