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Updated: Aug 31, 2025
Laparoscopic Common Bile Duct Exploration Followed by Primary Suture Using a Modified Bile Duct Incision
Published on: May 2, 2025
Emergency case of spontaneous common bile duct (CBD) perforation
Mohamad Halabi1, Neil Merritt1, Dhandapani Ashok1
1Department of Paediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario.
Insights
Spontaneous common bile duct (CBD) perforation in children is rare but serious. Early diagnosis and conservative management, as seen in this case, can lead to successful outcomes.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Case Reports
Background:
- Spontaneous common bile duct (CBD) perforation is an exceedingly rare pediatric surgical emergency.
- Delayed diagnosis in children often leads to significant morbidity and mortality.
Observation:
- A 22-month-old female presented with a month-long history of abdominal distension, pain, and jaundice.
- Exploratory laparotomy revealed significant bile-stained ascites.
Findings:
- The patient was successfully managed conservatively with external intra-abdominal drains for three weeks.
- Complete recovery was observed at the 6-month follow-up.
Implications:
- This case highlights the importance of considering spontaneous CBD perforation in pediatric patients with obstructive jaundice and abdominal symptoms.
- Timely diagnosis and appropriate management, even conservative, are crucial for favorable outcomes in this rare condition.
Abstract:
Spontaneous or non-traumatic common bile duct (CBD) perforation in children is a rare condition leading to difficulty and delay in diagnosis and resulting in high mortality. Presentation can vary significantly. Patients usually present with sudden obstructive jaundice, acholic stools, and abdominal pain and distension. Treatment tends to be surgical, consisting of CBD exploration, and possibly, repair. We report the case of a 22-month-old female with spontaneous CBD perforation. She presented with a 1-month history of increasing abdominal distension, abdominal pain, and jaundice. On exploratory laparotomy, a large amount of bile-stained ascitic fluid was drained. She was managed conservatively with 3 weeks of external intra-abdominal drains. Follow-up at 6 months showed complete recovery. Due to the rarity of spontaneous bile duct perforation, delayed diagnosis and intervention is common. Physicians must consider this diagnosis in a child with abdominal pain in order to prompt timely surgical management for a successful outcome.
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