[A case of spontaneous perforation of the common bile duct associated with cholangitis].
Spontaneous perforation of the common bile duct (CBD) is a rare event in adults. Most cases of CBD perforation are iatrogenic after invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP) or cholecystectomy. We report a case of an 81-year-old woman who presented with severe right upper abdominal pain, fever, and chills. Abdominal CT showed multiple gallbladder and CBD stones and loculated fluid collection in the inferoposterior portion of the stomach. ERCP showed the leakage of contrast media into the peritoneal cavity from the CBD. We performed endoscopic sphincterotomy (EST) and endoscopic nasobiliary drainage (ENBD) to decompress the CBD instead of emergent surgical intervention. One week later, cholangiography via ENBD tube revealed that there was no more leakage of the contrast media from the CBD. We performed cholecystectomy, removal of the CBD stones after exploration of the CBD, and T tube insertion. The perforated site of the CBD was closed and there was no more fluid collection in the inferoposterior portion of the stomach. Medical treatment including endoscopic procedures was useful for healing of the perforated CBD.
Yoo
Byoung Kwan
BK
Department of Internal Medicine, Hallym University College of Medicine, Anyang, Korea.
Kim
Jong Hyeok
JH
Moon
Hong Ju
HJ
Cheon
Won Seok
WS
Yoo
Ji Youn
JY
Kim
Jong Pyo
JP
Kim
Kyoung Oh
KO
Park
Cheol Hee
CH
Hahn
Tae Ho
TH
Yoo
Kyo Sang
KS
Park
Sang Hoon
SH
Lee
In Jae
IJ
Park
Choong Kee
CK
D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000150:complications*; D042883:Choledocholithiasis; D003137:Common Bile Duct Diseases / Q000209:etiology*; D005260:Female; D006801:Humans; D012422:Rupture, Spontaneous