Spontaneous bile duct perforation in an infant. A case report

A case of spontaneous perforation of the common bile duct in a 4-month-old girl is described. Perforation of the biliary tract is rare, but must be suspected in a child with pale stools, minimal or no jaundice and biliary ascites. Treatment is surgical. Patency of the distal biliary tract must be demonstrated by intra-operative cholecystocholangiography; drainage without repair of the perforation is then appropriate. If there is distal biliary tract obstruction, a biliary-intestinal anastomosis is needed. The difficulty of diagnosis is highlighted by the time between presentation and operation reported in many published cases; suggestions are made to aid a more rapid diagnosis.