Spontaneous non-traumatic common bile duct perforation presented as an acute abdomen: a rare case report

ABSTRACT

The spontaneous perforation of the biliary tract (SPBT) is an extremely rare cause of peritonitis, which was first described by Freeland in 1882, to date only around 70 cases have been reported. Here we present a case of spontaneous perforation of the biliary tract, in a patient with choledocholithiasis. A 45 years old male presented to us with acute abdomen with raised amylase and lipase s/o pancreatitis, imaging showed acute on chronic pancreatitis with impacted distal lumen in situ common bile duct (CBD) calculi. Patient was planned for ERCP with CBD clearance after his acute episode subsides. Meanwhile patient developed rigidity, guarding and distension. His second CECT showed a breach in the lower lateral segment in the CBD with gross ascites. Patient was planned for laparotomy, abdominal lavage and T-tube drainage. Patient had a stormy postoperative course. Patient recovered well and was discharged with T-tube clamped and subhepatic drain in situ. Spontaneous perforation of the extrahepatic bile duct is a rare but important presentation of gall stones. Conservative surgery that is decompression of the biliary tree and repair of the leak site over T-tube is the mainstay of treatment in the acute presentation.