Biliary Peritonitis Caused by Spontaneous Bile Duct Rupture in the Left Triangular Ligament of the Liver after Endoscopic Sphincterotomy for Choledocholithiasis

Abstract

Spontaneous bile duct rupture is a rare condition in adults, with only 70 cases reported. Increased bile duct wall pressure may lead to rupture and biliary peritonitis. In this patient, the bile duct ruptured in the hepatic left triangular ligament. A 91-year-old man underwent endoscopic retrograde cholangiopancreatography for choledocholithiasis and endoscopic retrograde biliary drainage (ERBD) placement. One week later, removal of the ERBD and common bile duct stones and an endoscopic sphincterotomy (EST) were performed. Four days later, the patient had abdominal pain, increased inflammatory reaction, and jaundice. Abdominal computed tomography showed ascites, bile duct dilatation and fluid collection under the liver (10 cm in diameter). Emergency surgery was performed to drain the fluid. On laparotomy, encapsulated biliary ascites was seen. To search for the site of the leak, after cholecystectomy, a tube (C-tube) was inserted into the common bile duct via cystic duct stump. Because of uncontrollable bleeding, after packing with surgical gauze, the operation was temporarily stopped. The next day, reoperation was performed. Intraoperative cholangiography with contrast dye revealed the perforation site in the left triangular ligament and a partial resection was performed. Bile excretion from the C-tube was subsequently observed, but the patient’s jaundice did not improve. Although endoscopic retrograde cholangiopancreatography revealed that the EST site was normal, ERBD was placed again, and the jaundice gradually improved. Although EST was performed in this case, biliary peritonitis resulting from spontaneous bile duct rupture occurred. This case was very informative because biliary perforation may occur even after EST.

A Novel Cause of Biliary Peritonitis after Endoscopic Retrograde Cholangiopancreatography: Case Report and Literature Review

“…In literature, the aforementioned condition has been scarcely reported, but its pathophysiology is associated with pathological changes in the liver parenchyma surrounding the ruptured bile duct: liver metastasis and abscesses [ 6 , 20 ]. There is one case report by Fukui et al [ 21 ] reporting a post-ERCP rupture of an intrahepatic duct, in otherwise, healthy liver parenchyma resulting in biliary peritonitis, but the rupture was associated with an innate anomaly identified as appendix fibrosa hepatis.…”

A large-scale dataset of patient summaries for retrieval-based clinical decision support systems

“…The second case presents a female patient with a history of atrial fibrillation and deep venous thrombosis who shows acute hepatobiliary symptoms. ReCDS retrieves highly relevant cases, covering most common conditions including cholecystitis 43 , bile leak 44 , and Mirizzi syndrome 45 . Impressively, ReCDS is able to bring up potentially dangerous bleeding complications (hemobilia), via suspecting anticoagulation use from her cardiac and thrombotic comorbidities 46 This requires further monitoring and testing, thus standing as important reminder in busy clinics where non-major medical problems can be easily ignored.…”

Spontaneous perforation in the bile duct system

“…Другой частой причиной разрыва желчных протоков левой доли печени является аберрантный желчный проток в левой треугольной связке [6]. В представленном обзоре разрыв аберрантного желчного протока левой треугольной связки отмечен в 2 наблюдениях [7,8], а у 8 больных произошел разрыв протоков II-III сегмента печени [6,[9][10][11][12][13][14][15].…”

“…Другим важным методом диагностики является ЭРХПГ, по результатам которой можно определить экстравазацию контрастного препарата [2,[37][38][39][40][41][42][43] или выявить косвенные признаки заболевания (холедохолитиаз, стриктура протока) [6,8,12,16,32,44,45]. В 3 наблюдениях применили билиосцинтиграфию [43,44,46], при этом в 2 наблюдениях определена миграция радиофармпрепарата за пределы билиарного тракта [43,44].…”