Biliary Peritonitis Due to Spontaneous Perforation of the Left Intrahepatic Bile Duct in an Adult: A Case Report and Review of Literature

Cai, Wenwu; Pan, Ke; Li, Qinglong; Miao, Xiangshui; Shu, Chang

doi:10.9738/intsurg-d-14-00264.1

Cited by 3 publications

(5 citation statements)

References 30 publications

(30 reference statements)

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“…SBDP usually affects children below the age of 4 years and is particularly reported in 6-month-old children. Studies have shown that 85% patients with SBDP are aged ≤2 years ( 3 ). In this study, more female than male patients were diagnosed with SBDP, with a ratio of 2.5:1.…”

Section: Discussionmentioning

confidence: 99%

“…Spontaneous bile duct perforation (SBDP) is a rare disease, mostly affecting children about 6 months of age, with the age at onset ranging from 25 weeks of gestation to 7 years after birth ( 1 – 3 ). The most common presentation of SBDP is abdominal distension, ascites, and jaundice; other symptoms may include localized or generalized peritonitis, pyrexia, and septic shock with or without signs and symptoms of a biliary tract disease ( 2 , 4 , 5 ).…”

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confidence: 99%

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Analysis of the Clinical Characteristics of Spontaneous Bile Duct Perforation in Children

et al. 2022

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ObjectiveThis study aimed to explore the etiology, clinical features, diagnosis, and treatment of spontaneous bile duct perforation (SBDP) in children.MethodsThe clinical data of children with SBDP who were admitted to Wuhan Children's Hospital between January 2014 and January 2020 were retrospectively analyzed.ResultsIn all, 28 cases of children with SBDP (male, 28.6%; female, 71.4%; male-to-female ratio, 1:2.5; average age, 2.15 years) were analyzed. The most common symptoms were fever (85.7%), nausea and vomiting (78.6%), and abdominal distension (67.9%). Among the 28 patients, 26 (92.9%) had elevated hypersensitive C-reactive protein, 24 (85.7%) had an increased neutrophil percentage, and 22 (78.6%) had raised peripheral blood leukocyte counts. Moreover, 19 patients (67.9%) showed increased serum total bilirubin levels, and 5 (17.9%) showed an elevated conjugated bilirubin level. Abdominal CT examination revealed that the gallbladder wall of patients was thickened with edema, accompanied by gallbladder stenosis and gallbladder mucosa enhancement; furthermore, ascites was found in the abdominal cavity and lesser omental bursa. Twenty-two patients underwent abdominal paracentesis, and 20 (90.9%) of them were exposed to bile-based ascites. Among the 28 patients, four recovered with conservative treatment, whereas the others (85.7%) were surgically treated. Of the twenty-four patients undergoing surgery, the perforation site was found at the union of the hepatic and cystic ducts in 12 patients (50%), no perforation site was observed in 9 patients (37.5%), and a common hepatic duct was observed in 3 patients (12.5%). All 24 patients underwent stage I surgery, and temporary biliary drainage was performed because of severe abdominal inflammation. Cholangiography and enhanced CT revealed an abnormal location of the pancreatic duct joining the bile duct in 64.3% patients. Following surgery, 15 patients underwent hepaticojejunostomy. Subsequently, 3-month to 6-year follow-up (median, 30 months) indicated that the patients recovered well with no serious complications.ConclusionSBDP in children may be associated with pancreaticobiliary malunion (PBM) and congenital weakness of the bile duct wall. However, the clinical manifestations of this condition lack specificity; this limitation can be assisted through diagnosis via abdominal CT and by performing abdominal paracentesis. Once SBDP diagnosis is confirmed, the patient should follow the principles of individualized treatment.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Analysis of the Clinical Characteristics of Spontaneous Bile Duct Perforation in Children

et al. 2022

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“…4,5 It is categorized into perforation of the intrahepatic bile duct and perforation of the extrahepatic bile duct of which the extrahepatic variety is much more common. 5,6 There are many etiological proposals given to explain the occurance of spontaneous bile duct perforation such as; bile duct obstruction due to stones, tumors or stricture with raised intraductal pressure; stones or tumors directly eroding the bile duct wall; bile duct diverticulum; vascular insufficiency to biliary tree. [7][8][9][10] It is seen that bile duct stones is the most common cause of bile duct perforation.…”

Section: Discussionmentioning

confidence: 99%

A case report of spontaneous biliary peritonitis with accessory liver lobe: rare presentation of a rare pathology

et al. 2021

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Spontaneous intrahepatic bile duct perforation with associated accessory liver lobe is an exceedingly rare condition with very few cases reported in the literature. Here we report a case of 76 years old man presenting with severe pain, abdominal distension since 3 days having jaundice and signs of peritonitis. Having undergone an exploratory laparotomy, 1 liter of bilious peritoneal fluid was seen with a perforation of left intra hepatic bile duct with a presence of an accessory lobe of liver. The gall bladder was contracted with multiple stones. Extrahepatic biliary duct was found normal intraoperatively. A cholecystectomy with resection of the accessory liver lobe was done. Post operatively patient had persistence of jaundice for which a magnetic resonance cholangiopancreatography was done, revealing a distal common bile duct calculus. Patient underwent endoscopic retrograde cholangiopancreatography with stone extraction on post operative day 10 relieving the symptoms. Patient is on regular follow up with no further complications. Awareness of such unusual occurrences is necessary for early diagnosis and instituting the appropriate treatment thereby reducing the mortality.

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“…[3] In rare cases, bile leakage can also be caused by spontaneous bile duct perforation. [4][5][6] In cases of bile peritonitis after right hemicolectomy, leakage of bowel contents due to anastomotic leakage is the first to be considered as a possible cause. However, we encountered 2 cases of bile leakage caused by injury of the intrahepatic bile duct after right hemicolectomy for colon cancer.…”

Section: Introductionmentioning

confidence: 99%

“…The possible causes of bile leakage after surgery include injury to the bile duct or duodenum during surgery, as well as gallbladder perforation due to cholecystitis, trauma, radiofrequency ablation, or endoscopic retrograde cholangiopancreatography (ERCP) [3] . In rare cases, bile leakage can also be caused by spontaneous bile duct perforation [4–6] …”

Section: Introductionmentioning

confidence: 99%

Postoperative bile leakage caused by intrahepatic duct injury during right hemicolectomy

Lee¹,

Song²,

Park³

et al. 2021

Medicine

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Introduction:Bile peritonitis is one of the rare complications that can occur after cholecystectomy or hepatectomy. It is associated with high mortality, prolonged hospital stay, and increased cost. We herein report 2 cases of bile leakage as a postoperative complication of right hemicolectomy.Patient concerns:Two patients underwent a right hemicolectomy for colon cancer. Both patients had a history of cholecystectomy, and intrahepatic bile duct dilatation was observed in preoperative imaging study. During surgery, adhesiolysis was performed between the liver and the hepatic flexure of the colon due to adhesion in that area.Diagnosis:Postoperatively, bile fluid was drained via an intraabdominal drainage tube. Both cases required surgical intervention to explore the origin of the leakage. In both cases, the anastomosis was intact, and the injury of the intrahepatic bile duct just beneath the liver surface was the origin of bile leakage.Interventions:Suture ligation, irrigation, and drainage were performed in both patients.Outcomes:There was no more bile leakage after reoperation, and both patients were discharged in good health after antibiotics treatment.Conclusion:Although very rare, bile leakage due to intrahepatic duct injury can occur after right hemicolectomy in patients with a history of cholecystectomy and intrahepatic duct dilatation. It is necessary to consider the possibility of bile duct injury and anastomotic leakage if bile leakage is suspected after right hemicolectomy.

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Biliary Peritonitis Due to Spontaneous Perforation of the Left Intrahepatic Bile Duct in an Adult: A Case Report and Review of Literature

Cited by 3 publications

References 30 publications

Analysis of the Clinical Characteristics of Spontaneous Bile Duct Perforation in Children

Analysis of the Clinical Characteristics of Spontaneous Bile Duct Perforation in Children

A case report of spontaneous biliary peritonitis with accessory liver lobe: rare presentation of a rare pathology

Postoperative bile leakage caused by intrahepatic duct injury during right hemicolectomy

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