title: Case report of non-traumatic spontaneous intrahepatic bile duct rupture in an adult.
abstract: BACKGROUND
  Spontaneous rupture of the biliary duct, a rare condition in adults, is difficult to diagnose preoperatively and presents with acute abdominal symptoms. The treatment of this rare condition should be based on the individual's clinical status. We present peripheric biliary duct rupture (segment three) treated with external segment III drainage and postoperative endoscopic removal of the stones.
  
  
  METHODS
  An 82-year-old male patient presented with abdominal pain and fever. An ultrasound (US) revealed a solid gall stone lesion, 3cm in diameter, in liver segments three and four with additional intra-abdominal fluid accumulation without coexisting free air. A diagnostic laparotomy was then performed because the patient had signs of peritonitis. Exploration revealed a biliary leakage from the posterior surface of segment three. An external biliary drainage catheter was inserted to the perforated segment III duct via a 6 French (6F) feeding catheter. He was discharged after 10 days and his intracholedocal stent was removed postoperative after three months. The patient continues to be monitored.
  
  
  CONCLUSIONS
  Spontaneous rupture of the intrahepatic biliary duct is a rare condition. Although occurrence is frequently reported as spontaneous, the majority of cases are related to choledocholithiasis. The role of surgical treatment in cases of spontaneous bile duct rupture is unclear. When biliary peritonitis is present, drainage of contaminated biliary fluid, T-tube drainage, closure of the biliary duct, as well as primary disease conditions, should be reviewed prior to treatment.
  
  
  CONCLUSIONS
  Surgical treatment of spontaneous biliary duct rupture should be indicated only after careful consideration of the patient's clinical and comorbidity status.
authors.affiliation: Department of surgery, Inonu University, Malatya, Turkey. Electronic address: fatihsumer@outlook.com.
authors.forename: Fatih
authors.initials: F
authors.lastname: Sumer
authors.affiliation: Department of surgery, Inonu University, Malatya, Turkey. Electronic address: cuneytkayaalp@hotmail.com.
authors.forename: Cuneyt
authors.initials: C
authors.lastname: Kayaalp
authors.affiliation: Department of surgery, Inonu University, Malatya, Turkey. Electronic address: servetkaragul@hotmail.com.
authors.forename: Servet
authors.initials: S
authors.lastname: Karagül
authors.affiliation: Department of surgery, Inonu University, Malatya, Turkey. Electronic address: is_ertugrul@hotmail.com.
authors.forename: Ismail
authors.initials: I
authors.lastname: Ertugrul
authors.affiliation: Department of surgery, Inonu University, Malatya, Turkey. Electronic address: maliyagci@gmail.com.
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Yagci
authors.affiliation: Department of surgery, Inonu University, Malatya, Turkey. Electronic address: fatih059@yahoo.com.
authors.forename: Asim
authors.initials: A
authors.lastname: Onur
keywords: Biliary duct; Bilioma; Choledocholithiasis; Spontaneous rupture