Early Spontaneous Common Bile Duct Perforation

Non-iatrogenic, non-traumatic common bile duct (CBD) perforation is a rare finding in the adult population and is more commonly reported in the pediatric population. Etiologies of CBD perforation in adults include traumatic injury, increased intraductal pressure due to choledocholithiasis, and biliary duct necrosis from underlying inflammation such as chronic pancreatitis. We present the case of a 59-year-old woman who initially presented with acute perforated cholecystitis with pancreatitis with intra-operative findings of a CBD perforation, which is not well-described in the literature. Management included endoscopic retrograde cholangiopancreatography with CBD stent placement and delayed cholecystectomy. This case is notable for the short period of symptoms prior to perforation and highlights the need for a higher degree of suspicion for alternative diagnoses when confronted with perforated cholecystitis.