Korean J Gastroenterol.  2005 May;45(5):361-364.

A Case of Spontaneous Perforation of the Common Bile Duct Associated with Cholangitis

• Yoo BK
• Kim JH
• Moon HJ
• Cheon WS
• Yoo JY
• Kim JP
• Kim KO
• Park CH
• Hahn TH
• Yoo KS
• Park SH
• Lee IJ
• Park CK

Abstract

Spontaneous perforation of the common bile duct (CBD) is a rare event in adults. Most cases of CBD perforation are iatrogenic after invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP) or cholecystectomy. We report a case of an 81-year-old woman who presented with severe right upper abdominal pain, fever, and chills. Abdominal CT showed multiple gallbladder and CBD stones and loculated fluid collection in the inferoposterior portion of the stomach. ERCP showed the leakage of contrast media into the peritoneal cavity from the CBD. We performed endoscopic sphincterotomy (EST) and endoscopic nasobiliary drainage (ENBD) to decompress the CBD instead of emergent surgical intervention. One week later, cholangiography via ENBD tube revealed that there was no more leakage of the contrast media from the CBD. We performed cholecystectomy, removal of the CBD stones after exploration of the CBD, and T tube insertion. The perforated site of the CBD was closed and there was no more fluid collection in the inferoposterior portion of the stomach. Medical treatment including endoscopic procedures was useful for healing of the perforated CBD.

Keyword

Perforation; Common bile duct; Endoscopic nasobiliary drainage

MeSH Terms

Aged, 80 and over
Cholangiopancreatography, Endoscopic Retrograde
Cholangitis/*complications
Choledocholithiasis
Common Bile Duct Diseases/*etiology
Female
Humans
Rupture, Spontaneous