J Korean Soc Radiol.  2011 Sep;65(3):267-270.

Spontaneous Perforation of Common Bile Duct in a Child with a Clinical Manifestation of Acute Abdominal Distension: A Case Report

• Jeong HR
• Namkung S
• Kim HC
• Hong MS

Abstract

Spontaneous perforation of common bile duct (CBD) is extremely rare in children, but potentially a fatal disorder that requires an emergency laparotomy. Most of the patients present with insidious symptoms including slowly progressive abdominal distension with accumulation of the ascites, fluctuating mild jaundice, and clay-colored stools. We report a case of surgically confirmed spontaneous perforation of the CBD in a 3-year-old girl who presented with acute abdominal distension with no biliary symptoms or signs, and who showed imaging findings consistent with anomalous pancreaticobiliary ductal union with a focal stenosis in the CBD.

MeSH Terms

Ascites
Child
Common Bile Duct
Constriction, Pathologic
Emergencies
Humans
Jaundice
Laparotomy
Preschool Child

Figure

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  Fig. 1 Plain abdominal supine radiography shows abdominal distension with widening of both paracolic gutters (arrows), suggesting ascites.

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  Fig. 2 CT coronal image shows diffuse ascites distributed in whole abdomen, and there is no biliary dilatation.

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  Fig. 3 Intraoperative cholangiogram shows an anomalous pancreaticobiliary ductal union with stenosis (long arrow) in the mid-CBD and protein plugs (short arrows) in the common channel (arrowhead; pancreatic duct). Note.-CBD = common bile duct

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  Fig. 4 Post-operative one month follow-up MRCP shows an anomalous pancreaticobiliary ductal union with CBD stenosis (long arrow) and protein plugs (short arrows) in the common channel. Note.-CBD = common bile duct, MRCP = magnetic resonance cholangio pancreatography

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