Acute Abdomen Secondary to a Spontaneous Perforation of the Biliary Tract, a Rare Complication of Choledocholithiasis.

INTRODUCTION: The spontaneous perforation of the biliary tract (SPBT) is an extremely rare cause of peritonitis, which was first described by Freeland in 1982, 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, which was treated with ultrasound-guided drainage and ERCP. CASE REPORT: A 51-year-old male was admitted to the emergency room for 15-day evolution jaundice, localized pain in the right flank and hypochondrium of 3days. He had a history of cholecystectomy 15 years ago and 4 episodes of cholangitis, the last one in 2015. A magnetic resonance imaging (MRI) was performed, that showed evidence of choledocholithiasis, in addition to a possible biliary leakage. The patient was treated with ultrasound-guided drainage and ERCP successfully. DISCUSSION: Spontaneous perforation of the biliary tract is a disease entity in which wall of the extrahepatic or intrahepatic duct is perforated without any traumatic or iatrogenic injury. The clinical presentation varies from nonspecific abdominal pain to biliary peritonitis, in most of the cases forming bilomas. Universal management involves decompression of the biliary tree and repair of the leak site. CONCLUSION: The spontaneous perforation of the biliary tract is a disease that represents a diagnostic challenge. The treatment in the patients with SPBT is not well established and has to be individualized for each case, depending on the history of the patient, the site of perforation, the time of evolution, the suspicion of infection, and the patient status.

[Cancer in Spain (1977-1987): an analysis of the Hospital Morbidity Survey]. / El cáncer en España (1977-1987): análisis de la Encuesta de Morbilidad Hospitalaria.

The aim of the present work is to evaluate the usefulness of the Hospital Morbidity Survey for the study of cancer morbidity in Spain. The study covers the period 1977-1987. Age-standardized rates for the following groups have been estimated: "hospital admissions by sex, age and final diagnosis" and "hospital admissions (new cases) by age, sex and final diagnosis". During the period 1983-84 an important increase in the frequency of all malignant tumours has coincided with an equivalent decrease in the non-specified category, leading to the conclusion that an information bias is present. This bias limits the study of temporal series of cancer morbidity in Spain and suggests that a modification of the Spanish Hospital Morbidity Survey is urgently needed.