Surgical management of spontaneous hepatic duct perforations

Spontaneous rupture of the hepatic ducts is an exceedingly rare and unusually unrecognized cause of peritonitis in adults. In the last four years we have operated on three patients with bile peritonitis from hepatic duct perforation caused by calculus erosion. All were elderly, had a prolonged period of symptoms prior to presentation, and were gravely ill at the time of operation. Each perforation was managed differently: one by fine suture closure, one by insertion of a T-tube in the perforation, and the third by T-tube drainage of the common duct when the perforation was inaccessible to repair. Two of the three patients survived and remain healthy without evidence of bile duct stricture three and three and a half years later, respectively.