Endoscopic Management of Spontaneous Perforation of a Cystic Duct in a 10-year-old Child

Abstract

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.

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

“…In the past few decades, endoscopic instrumentation and techniques have evolved rapidly, and because of their noninvasive nature and prognosis after treatment, they have gradually replaced laparotomy. [29][30][31][32] But once the patient has developed diffuse peritonitis or even shock, such as in this case, an exploratory laparotomy is essential. According to the intraoperative condition of the patient, the operation could be a cholecystectomy, a cholecystostomy, a bile duct exploration, T-tube drainage, repair of the perforated site, or even cutting of the perforation.…”

Paediatric infant presenting with an atypical spontaneous biliary perforation

“…Some authors do not recommend exploration of the porta hepatis as inflammation significantly increases technical difficulty [21]. Endoscopic retrograde cholangiopancreatography has been used in both diagnostic and therapeutic modalities [11,22]. However, there are significantly limited resources and qualified personnel capable of investigating and treating paediatric SBP with endoscopic retrograde cholangiopancreatography.…”