[Spontaneous bile duct perforation: a rare cause of acute abdominal pain during childhood].
BACKGROUND
Spontaneous perforation of the bile duct (SPBD) is a rare cause of acute abdominal pain during childhood. Pancreatico-biliary malfunction has been postulated to contribute to its etiology. Factors related to diagnosis and treatment and difference from the other common causes of acute abdominal pain are emphasized.


METHODS
Five patients (3 boys, 2 girls, mean age 4.6) were admitted with peritonitis and operated with initial diagnosis of perforated appendicitis. During laparotomy, SPBD was detected. Presentation, laboratory findings and operative technique of the patients were evaluated retrospectively.


RESULTS
Common complaints were abdominal pain and bilious vomiting. Abdominal distention was present in all patients. Leukocytosis and mild hyperbilirubinemia were detected in 5, elevated serum transaminase levels in 4, hyperglycemia in 1 and constipation in 1 patient(s). Abdominal ultrasonography showed a large amount of free fluid. During laparotomy, sterile bile peritonitis was detected initially. After exploration, SPBD was seen. T-tube drainage of the bile duct was carried out. Patients were discharged after removal of the T-tubes. Pancreatico-biliary malfunction was detected in 4 of 5 patients.


CONCLUSIONS
In patients with generalized peritonitis, elevated transaminase levels and hyperbilirubinemia, SPBD must be considered. Even though the T-tube drainage is the treatment of choice, Roux-en-Y hepatico-portoenterostomy may be mandatory in certain patients.
Ozdemir
Tunç
T
Department of Pediatric Surgery, Tepecik Training and Research Hospital, Izmir, Turkey. ozdemirtunc@yahoo.com
Akgül
Ahsen Karagözlü
AK
Arpaz
Yağmur
Y
Arikan
Ahmet
A
D015746:Abdominal Pain / Q000209:etiology; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D010538:Peritonitis / Q000150:complications* / Q000601:surgery; D012189:Retrospective Studies