Spontaneous perforation of bile ducts

Area of Science:

• Gastroenterology and Hepatobiliary Surgery

Background:

• Spontaneous perforation of bile ducts is an exceptionally rare event, with limited documented cases in medical literature.
• Previous literature reviews identified only 23 common bile duct perforations and 10 common hepatic duct perforations.

Observation:

• This report details two additional cases of spontaneous bile duct perforation.
• One case involved the distal common hepatic duct, and the other affected a small hepatic duct radical on the liver's inferior surface.

Findings:

• Common etiological factors include choledochal calculi (gallstones), infected bile, and elevated pressure within the proximal biliary system.
• The presence of free bile or bile-stained fluid in the peritoneal cavity, with an intact gallbladder, should raise suspicion for bile duct perforation.

Implications:

• Prompt surgical recognition and appropriate management are vital for successful outcomes in spontaneous bile duct perforation.
• Understanding these rare occurrences aids in surgical preparedness and patient care for biliary emergencies.