A 10-year-old boy presented to us with acute abdominal pain and vomiting. The patient was stable on clinical examination. On ultrasound and computed tomography scan of the abdomen he had persistent peritoneal collection with edematous pancreas. Abdominal paracentesis revealed bile and 99m Tc HIDA (hepatobiliary iminodiacetic acid) scan showed a biliary leak. A percutaneous drain was inserted for collection, and endoscopic retrograde cholangiopancreatography (ERCP) was performed. A spontaneous cystic duct perforation was confirmed on ERCP and a biliary stent was inserted. The patient's general condition improved, his percutaneous drain was removed on day 6 post ERCP and the biliary stent removed after 3 months. The patient is asymptomatic and doing well at 6 months' follow up. Spontaneous perforation of a cystic duct is an extremely rare condition with very few reported cases in the literature. Radionuclide scanning and ERCP are reliable modes for diagnosis and localization of the site of the leak. ERCP and biliary stenting are successful in the management of these patients.
Retroperitoneal schwannomas are though more common among females, are very much rare tumors arising from sheath of nerves. Also, extremely rare during pregnancy. Very few articles till date are there regarding retroperitoneal schwannomas that’s too in pregnant female. Usually these are symptomatic unless causing some compression to other intra-abdominal structures like vessels or bowel and usually malignant. As its retroperitoneal very difficult to diagnose it. So, with proper investigations and radiological imaging, first have to find out the differential diagnosis prior to planning for surgery.
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