A rare cause of acute abdomen: spontaneous common hepatic duct perforation
Hüseyin Pülat1, Oktay Karaköse1, Mehmet Fatih Benzin2
1Department of Surgical Oncology, Suleyman Demirel University Faculty of Medicine, Isparta, Turkey.
Insights
Spontaneous extrahepatic bile duct perforation is rare in adults but can cause fatal bile peritonitis. Prompt imaging and emergency surgery are crucial for diagnosis and management of this acute abdomen cause.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Pathology
Background:
- Spontaneous extrahepatic bile duct perforation is predominantly observed in infants.
- In adults, this condition is exceedingly rare but can lead to life-threatening bile peritonitis.
Observation:
- The study presents a rare case of spontaneous common hepatic duct perforation in an adult presenting with acute abdominal symptoms.
- Radiological imaging, including abdominal ultrasonography and computed tomography, is essential for prompt diagnosis.
Findings:
- The case highlights the importance of considering spontaneous bile duct perforation in the differential diagnosis of acute abdomen in adults, especially when accompanied by gallstone disease and perihepatic free fluid.
- Inability to visualize the common bile duct (choledochus) on imaging warrants suspicion.
Implications:
- Early diagnosis through advanced imaging and prompt emergency surgical intervention are critical to prevent severe complications associated with bile peritonitis.
- This case underscores the need for heightened clinical awareness of rare causes of acute abdomen in adult patients.
Abstract:
Spontaneous extrahepatic bile duct perforation is generally seen in infants. Although rarely seen in adults, it may be seen with fatal bile peritonitis. Therefore, for a patient presenting with acute abdominal symptoms, differential diagnosis must be made with radiological imaging such as abdominal ultrasonography or computed tomography, without any loss of time. In these imaging tests, in cases of gallstone disease together with perihepatic free fluid or choledocus which can not be monitored, it should be considered in the differential diagnosis. An emergency surgical intervention should be planned to avoid serious complications. The aim of this paper was to present the rare cause of acute abdomen which developed associated with spontaneous common hepatic canal perforation in an adult.
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