title: [Spontaneous bile duct perforation: a rare cause of acute abdominal pain during childhood].
abstract: 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.
authors.affiliation: Department of Pediatric Surgery, Tepecik Training and Research Hospital, Izmir, Turkey. ozdemirtunc@yahoo.com
authors.forename: Tunç
authors.initials: T
authors.lastname: Ozdemir
authors.forename: Ahsen Karagözlü
authors.initials: AK
authors.lastname: Akgül
authors.forename: Yağmur
authors.initials: Y
authors.lastname: Arpaz
authors.forename: Ahmet
authors.initials: A
authors.lastname: Arikan
mesh_terms: 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