title: Simultaneous non-traumatic perforation of the right hepatic duct and gallbladder: an atypical occurrence.
abstract: Simultaneous non-traumatic perforation of the extrahepatic bile duct and the gallbladder is an uncommon occurrence that has been infrequently reported. We describe a patient with a spontaneous perforation of both the extrahepatic bile duct and the gallbladder. A contrast-enhanced computed tomography (CECT) scan of the abdomen and endoscopic retrograde cholangiopancreatography (ERCP) demonstrated a perforation of the gallbladder and a free leak from the right hepatic duct, respectively. Endoscopic biliary drainage following a sphincterotomy and biliary stent placement led to a dramatic improvement in the patient's general condition. He was subsequently scheduled to undergo an elective cholecystectomy. Repeat ERCP performed at 4 weeks after the initial stenting showed a normal cholangiogram and a distally migrated stent, which was there after removed. However, early stent removal led to re-perforation of hepatic duct and gallbladder. A repeat endoscopic biliary drainage did not help, and the patient developed biliary peritonitis. Surgical exploration revealed a perforation at the fundus of the gallbladder, 400 ml of biliopurulent collection and a frozen Calot's triangle. A subtotal cholecystectomy, gall stone removal, and a thorough peritoneal lavage were undertaken. The patient improved postoperatively. The second biliary stent was removed after 4 months. This case report highlights the role of endoscopic biliary drainage in the management of an extrahepatic bile duct perforation and warns against the early removal of a biliary stent.
authors.affiliation: Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi 110095, India.
authors.forename: Pankaj Kumar
authors.initials: PK
authors.lastname: Garg
authors.forename: Bhupendra Kumar
authors.initials: BK
authors.lastname: Jain
authors.forename: Satya Deo
authors.initials: SD
authors.lastname: Pandey
authors.forename: Vinita
authors.initials: V
authors.lastname: Rathi
authors.forename: Amarendra Singh
authors.initials: AS
authors.lastname: Puri
keywords: CT scan; ERCP; gallbladder; hepatic duct; perforation