Spontaneous perforation of choledochal cyst.
BACKGROUND
Spontaneous perforation of the common bile duct in children is very rare and its etiology is unknown. We describe herein five patients treated for the spontaneous perforation of choledochal cyst and suggest the important factors leading to perforation.


METHODS
All patients were initially treated with T-tube drainage through the perforated site. Cholangiography through the T tube was performed intraoperatively and the important factors leading to perforation were examined. Furthermore, histological examination of the perforated wall of the common bile duct was performed.


RESULTS
Cholangiography through a T tube revealed the presence of a pancreaticobiliary junction malformation and filling defects (protein plugs) in the common channel in all patients. Postoperatively, the T tube was gently irrigated with a physiological salt solution until the free flow of bile into the duodenum was established. Histological examination showed that the wall near the perforation was covered with a granulation tissue that was present only at the limited area.


CONCLUSIONS
Perforation of the common bile duct was related to the abrupt increase in intraluminal pressure due to obstruction by protein plugs at the common channel.
Ando
H
H
Department of Surgery, Branch Hospital, University of Nagoya School of Medicine, Japan.
Ito
T
T
Watanabe
Y
Y
Seo
T
T
Kaneko
K
K
Nagaya
M
M
D000713:Anastomosis, Roux-en-Y; D002648:Child; D002675:Child, Preschool; D002758:Cholangiography; D015529:Choledochal Cyst / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D001651:Cholestasis, Extrahepatic / Q000150:complications; D003135:Common Bile Duct / Q000002:abnormalities / Q000473:pathology; D003137:Common Bile Duct Diseases / Q000150:complications; D004322:Drainage / Q000295:instrumentation; D006097:Granulation Tissue / Q000473:pathology; D006801:Humans; D007223:Infant; D007430:Intraoperative Care; D007440:Intubation / Q000295:instrumentation; D007813:Laparotomy; D010183:Pancreatic Ducts / Q000002:abnormalities / Q000473:pathology; D015641:Radiography, Interventional; D012421:Rupture