title: T tube drainage for spontaneous perforation of the extrahepatic bile duct.
abstract: BACKGROUND
  Spontaneous perforation of the extrahepatic bile duct is very rare. We report a patient with a spontaneous perforation of the left hepatic bile duct who was diagnosed preoperatively.
  
  
  METHODS
  A 65-year-old woman was admitted to our hospital complaining of a right upper quadrant pain lasting for two days. She was diagnosed as having a perforated bile duct and peritonitis and underwent a laparotomy. After a cholecystectomy, T-tube drainage of the left hepatic duct was performed. The postoperative course was uneventful. The T tube was removed 25 days after the surgery.
  
  
  CONCLUSIONS
  A more noninvasive procedure, such as endoscopic treatment, should play a central role in the management of extra bile duct perforation. For this case, however, we chose to perform a laparotomy based on the patient's general condition and the presence of peritonitis. T tube decompression is effective and a safe and reliable method. The goal of treatment is to stop the bile leakage, resolve the choledocholithiasis and cholangitis, and reconstruct the bile duct.
authors.affiliation: Institute of Gastroenterology Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan. mizutani@nms.ac.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Mizutani
authors.forename: Aki
authors.initials: A
authors.lastname: Yagi
authors.forename: Masanori
authors.initials: M
authors.lastname: Watanabe
authors.forename: Kentaro
authors.initials: K
authors.lastname: Maejima
authors.forename: Osamu
authors.initials: O
authors.lastname: Komine
authors.forename: Masanori
authors.initials: M
authors.lastname: Yoshino
authors.forename: Masao
authors.initials: M
authors.lastname: Ogata
authors.forename: Arichika
authors.initials: A
authors.lastname: Hoshino
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Suzuki
authors.forename: Akira
authors.initials: A
authors.lastname: Tokunaga
authors.forename: Eiji
authors.initials: E
authors.lastname: Uchida
mesh_terms: D000368:Aged; D017734:Bile Ducts, Extrahepatic / Q000293:injuries*; D002763:Cholecystectomy; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D007813:Laparotomy; D012422:Rupture, Spontaneous