Management of biliary perforation in children.
BACKGROUND
To study the aetiology, management and outcome of biliary perforations in paediatric age group.


METHODS
In a retrospective study, the records of patients presented with biliary peritonitis due to biliary perforations, managed from March 2006 to July 2009, are reviewed.


RESULTS
Eight male patients with biliary peritonitis due to biliary perforation were managed. These patients were divided in two groups, A and B. Group A, (n = 3) patients, had common bile duct (CBD) perforation, and Group B (n=5) patients had gallbladder perforation. The presenting features were abdominal pain, fever, abdominal distension, vomiting, constipation, jaundice and signs of peritonism. The management of CBD perforations in Group A was by draining the site of perforation and biliary diversion (tube cholecystostomy). In Group B, the gallbladder perforations were managed by tube cholecystostomy in four patients and cholecystectomy in one patient, however, one patient had to be re-explored and cholecystectomy performed due to complete necrosis of gall bladder. There was no mortality in our series. All patients were asymptomatic on regular follow-up.


CONCLUSIONS
Early optimal management of biliary perforations remarkably improved the very high mortality and morbidity that characterised this condition in the past.
Mirza
Bilal
B
Department of Paediatric Surgery, The Children's Hospital and The Institute of Child Health, Lahore, Pakistan. blmirza@yahoo.com
Ijaz
Lubna
L
Saleem
Muhammad
M
Iqbal
Shahid
S
Sharif
Muhammad
M
Sheikh
Afzal
A
D001649:Bile Duct Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy; D002767:Cholecystostomy; D003135:Common Bile Duct / Q000293:injuries*; D005704:Gallbladder / Q000293:injuries*; D005705:Gallbladder Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D010538:Peritonitis / Q000209:etiology* / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome