Simultaneous Non-Traumatic Perforation of the Right Hepatic Duct and Gallbladder: An Atypical Occurrence

Simultaneous non-traumatic perforation of the extrahepatic bile duct and the gallbladder is an uncommon occurrence that has been infrequently reported. We describe a patient with a spontaneous perforation of both the extrahepatic bile duct and the gallbladder. A contrast-enhanced computed tomography (CECT) scan of the abdomen and endoscopic retrograde cholangiopancreatography (ERCP) demonstrated a perforation of the gallbladder and a free leak from the right hepatic duct, respectively. Endoscopic biliary drainage following a sphincterotomy and biliary stent placement led to a dramatic improvement in the patient’s general condition. He was subsequently scheduled to undergo an elective cholecystectomy. Repeat ERCP performed at 4 weeks after the initial stenting showed a normal cholangiogram and a distally migrated stent, which was there after removed. However, early stent removal led to re-perforation of hepatic duct and gallbladder. A repeat endoscopic biliary drainage did not help, and the patient developed biliary peritonitis. Surgical exploration revealed a perforation at the fundus of the gallbladder, 400 ml of biliopurulent collection and a frozen Calot’s triangle. A subtotal cholecystectomy, gall stone removal, and a thorough peritoneal lavage were undertaken. The patient improved postoperatively. The second biliary stent was removed after 4 months. This case report highlights the role of endoscopic biliary drainage in the management of an extrahepatic bile duct perforation and warns against the early removal of a biliary stent.

Papillary cystadenocarcinoma of ovary presenting as obstructive jaundice: a rare presentation

Obstructive jaundice resulting from malignancy of gastrointestinal tract and hepatobiliary tract has been reported in various studies. Ovarian malignancy leading to obstructive jaundice due to portal lymphadenopathy is of rare occurrence. We report a case presented with obstructive jaundice and on further evaluation, found to have ovarian papillary cyst adenocarcinoma with secondaries at porta hepatis which was managed successfully by neoadjuvant chemotherapy followed by cytoreductive surgery

blind-ending ureter with infection due to vesicoureteric reflux with associated renal agenesis: a rare cause of pain abdomen

We report a 12-year-old male child with an unusual cause of abdominal pain, i.e. a blind-ending ureter with vesicoureteral reflux. The pain improved with antibiotic therapy, implying infection as the cause of pain. This entity is difficult to diagnose clinically, thereby affecting management. Usually, a blind-ending ureter is not filled on intravenous urography [IVU] and the diagnosis is confirmed by retrograde pyelography, which is an invasive procedure. We illustrate the contribution of IVU and computerized tomographic cystography, which has not been reported earlier, in the evaluation of such cases