title: Bile Duct Perforation due to Inspissated Bile Presenting as Refractory Ascites.
abstract: Non hepatic origin of refractory ascites is not a rarity. Hemolytic anemias are known to cause inspissated bile and biliary obstruction. Distal biliary obstruction can lead to biliary perforation. The authors report a case of hereditary spherocytosis leading to inspissated bile causing bile duct perforation and biliary ascites. A high index of suspicion for biliary ascites should be kept in a child with refractory ascites in the setting of progressive ascites with decreasing bilirubin. Ascitic fluid bilirubin analysis will clinch the diagnosis. Surgical repair is the optimal management.
authors.affiliation: Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India. bikrant18may@gmail.com.
authors.forename: Bikrant Bihari
authors.identifier: http://orcid.org/0000-0001-6275-7736
authors.initials: BB
authors.lastname: Lal
authors.affiliation: Department of Hepatobiliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Kishore G
authors.initials: KG
authors.lastname: Bharathy
authors.affiliation: Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
authors.forename: Seema
authors.initials: S
authors.lastname: Alam
authors.affiliation: Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Khanna
authors.affiliation: Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Yashwant
authors.initials: Y
authors.lastname: Patidar
authors.affiliation: Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Rawat
mesh_terms: D001201:Ascites / Q000209:etiology*; D001646:Bile; D001652:Bile Ducts / Q000293:injuries*; D002779:Cholestasis / Q000150:complications*; D005260:Female; D006801:Humans; D007223:Infant; D012422:Rupture, Spontaneous
keywords: Biliary perforation; Hereditary spherocytosis; Inspissated bile; Refractory ascites