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Biliary Peritonitis due to Spontaneous Perforation of Choledochus: A Case Report

Mushtaq A Laway1, Iftikhar H Bakshi1, Mubbashir Shah1

  • 1Department of General and Minimal Access Surgery, Sher-i- Kashmir Institute of Medical Sciences, F-24, C-Block, Married Doctors Hostel, Kashmir, India.

The Indian Journal of Surgery
|January 16, 2014
PubMed

Insights

Spontaneous common bile duct (CBD) perforation is rare in adults. This case highlights the diagnostic challenges and need for prompt management of this critical condition.

Area of Science:

  • Gastroenterology and Hepatobiliary Surgery
  • Surgical Case Reports

Background:

  • Spontaneous perforation of the common bile duct (CBD) is exceptionally rare in adults, contrasting with its occurrence in infants due to congenital issues.
  • Biliary tract perforations often present with nonspecific symptoms, leading to diagnostic delays and increased patient morbidity and mortality.

Purpose of the Study:

  • To report a rare case of spontaneous common bile duct perforation in an adult male.
  • To emphasize the diagnostic difficulties and management strategies for this uncommon surgical emergency.

Main Methods:

  • A middle-aged male presented with acute abdominal pain.
  • Diagnostic workup included clinical evaluation and exploratory laparotomy.
  • Surgical management involved a T-tube drain for the perforation.

Main Results:

  • Exploratory laparotomy identified a small perforation with necrosed margins in the supraduodenal portion of the CBD.
  • The perforation was successfully managed with a T-tube drain.
  • No specific etiology for the spontaneous perforation was identified.

Conclusions:

  • Spontaneous CBD perforation in adults is a rare but serious condition requiring high clinical suspicion.
  • Prompt diagnosis and aggressive surgical management are crucial to improve outcomes and reduce morbidity and mortality.
  • Further investigation into the underlying causes of spontaneous perforation in adults may be warranted.

Keywords:
Common bile duct perforationPeritonitisSpontaneousT-tube decompression

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