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CASE REPORT
Year : 2016  |  Volume : 14  |  Issue : 2  |  Page : 46-48

Spontaneous common bile duct perforation in an adult female patient presenting with severe epigastric pain mimicking acute pancreatitis


1 Department of Tropical Medicine, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
2 Department of General Surgery, Faculty of Medicine, Al-Azhar University, Assiut, Egypt

Correspondence Address:
Muhammad Abd El-Gawad Shawky
Department of Tropical Medicine, Faculty of Medicine, Al-Azhar University, Assiut, 71524
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1687-1693.192649

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Spontaneous common bile duct (CBD) perforation is a rare event, and mostly occurs in infants with CBD stones and rarely occurs in adults. A 19-year-old female patient presented to us with severe acute epigastric pain mimicking acute pancreatitis, together with vomiting, abdominal distention, and tenderness. Abdominal radiograph and upper gastrointestinal tract endoscopy were normal. Abdominal ultrasound and computed tomography showed retroperitoneal collection near the pancreas. Diagnostic aspiration showed greenish yellow turbid aspirate with very high bilirubin in ascitic fluid than in serum. The case complicated with biliary peritonitis. Laparotomy was performed, and revealed posterior CBD perforation. Peritoneal washing was carried out with removal of about 6 l of bile. Cholecystectomy with CBD exploration was performed, and the CBD was closed over a T-tube and external drainage was carried out. The patient stayed in hospital for 17 days postoperatively and was discharged after removal of the T-tube and drain. She came for follow-up after 1 month from discharge in a very good general condition.


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