title: Bile duct perforation in children: is it truly spontaneous?
abstract: BACKGROUND
  Bile duct perforation (BDP) with resultant biliary ascites in children is a rare clinical condition. The aetiopathogenesis is still an enigma, with increasing evidence suggesting anomalous union of pancreaticobiliary ductal (AUPBD) system as the prime causative factor.
  
  
  METHODS
  We report 2 cases of spontaneous perforation of the bile duct confirmed on histopathological examination as choledochal cyst, in a 6-month-old female child and a 4-year-old boy who presented with subtle clinical symptoms.
  
  
  RESULTS
  Both patients were successfully managed by excision of the gall bladder and common bile duct and Roux-en- Y hepaticojejunostomy. This procedure was performed following initial cholecystostomy drainage in the second case.
  
  
  CONCLUSIONS
  From the available literature and experience with our patients, BDP is not merely spontaneous but may be related to AUPBD and choledochal cyst.
authors.affiliation: Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore. trsai@rediffmail.com
authors.forename: T R
authors.initials: TR
authors.lastname: Sai Prasad
authors.forename: Chan Hon
authors.initials: CH
authors.lastname: Chui
authors.forename: Yee
authors.initials: Y
authors.lastname: Low
authors.forename: Chia Li
authors.initials: CL
authors.lastname: Chong
authors.forename: Anette Sundfor
authors.initials: AS
authors.lastname: Jacobsen
mesh_terms: D001201:Ascites / Q000209:etiology / Q000601:surgery; D001652:Bile Ducts / Q000293:injuries*; D002675:Child, Preschool; D002758:Cholangiography; D002763:Cholecystectomy; D015529:Choledochal Cyst / Q000150:complications / Q000601:surgery*; D003135:Common Bile Duct / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D007582:Jejunostomy; D010535:Laparoscopy; D008297:Male; D014057:Tomography, X-Ray Computed