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Bile duct perforation in children: is it truly spontaneous?
T R Sai Prasad1, Chan Hon Chui, Yee Low
1Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore. trsai@rediffmail.com
Introduction:
Bile duct perforation (BDP) with resultant biliary ascites in children is a rare clinical condition. The aetiopathogenesis is still an enigma, with increasing evidence suggesting anomalous union of pancreaticobiliary ductal (AUPBD) system as the prime causative factor.
Clinical Picture:
We report 2 cases of spontaneous perforation of the bile duct confirmed on histopathological examination as choledochal cyst, in a 6-month-old female child and a 4-year-old boy who presented with subtle clinical symptoms.
Treatment And Outcome:
Both patients were successfully managed by excision of the gall bladder and common bile duct and Roux-en- Y hepaticojejunostomy. This procedure was performed following initial cholecystostomy drainage in the second case.
Conclusions:
From the available literature and experience with our patients, BDP is not merely spontaneous but may be related to AUPBD and choledochal cyst.
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