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Spontaneous perforation of the extrahepatic bile duct in an infant
L S Kasat1, S S Borwankar, M Jain
1Department of Pediatric Surgery, KEM Hospital, Parel, Mumbai, India.
Insights
Spontaneous bile-duct perforation (SPBD) in a child caused biliary ascites and failure to thrive. Non-surgical management with peritoneal drainage successfully sealed the perforation, highlighting a conservative approach for SPBD without distal obstruction.
Area of Science:
- Pediatric Gastroenterology
- Hepatobiliary Surgery
- Medical Imaging
Background:
- Spontaneous bile-duct perforation (SPBD) is a rare condition in pediatric patients.
- Biliary ascites and failure to thrive are significant clinical manifestations.
- Accurate diagnosis is crucial for appropriate management.
Observation:
- A 1.2-year-old male presented with gradual biliary ascites, mild icterus, and failure to thrive.
- Technetium 99Tc HIDA scan and abdominal paracentesis confirmed SPBD.
- No distal obstruction was identified.
Findings:
- Peritoneal tube drainage for two weeks led to spontaneous sealing of the bile-duct perforation.
- Conservative management was successful, avoiding the need for surgical intervention.
- This case adds to the limited reported cases of SPBD in the English literature.
Implications:
- Non-surgical management can be effective for SPBD in pediatric cases without distal obstruction.
- Early diagnosis and conservative treatment may prevent the need for invasive procedures.
- Further research into the pathogenesis and optimal treatment strategies for SPBD is warranted.
Abstract:
A 1.2-year-old male presented with gradual-onset biliary ascites, mild icterus, and failure to thrive due to spontaneous bile-duct perforation (SPBD) confirmed by technetium 99Tc HIDA scan and abdominal paracentesis. Peritoneal tube drainage for 2 weeks helped the perforation to seal spontaneously, as there was no distal obstruction. No surgery was needed. Only less than 100 cases of SPBD have been reported in the English literature. The pathogenesis and treatment options are reviewed and discussed.