Nontraumatic Perforation of the Bile Duct in Adults | Hepatobiliary Disease | JAMA Surgery | JAMA Network
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Original Article
October 2004

Nontraumatic Perforation of the Bile Duct in Adults

Author Affiliations

From the Department of Surgery, Seoul National University Bundang Hospital (Drs Kang and Han), Department of Surgery, College of Medicine, Ewha Woman's University (Drs Min and Lee), Seoul, Korea.

Arch Surg. 2004;139(10):1083-1087. doi:10.1001/archsurg.139.10.1083
Abstract

Hypothesis  Nontraumatic perforation of the bile duct in adults is rare, and the management of this condition should resolve the primary pathologic lesion.

Design  Retrospective analysis of 11 patients who were diagnosed as having nontraumatic perforation of the bile duct.

Setting  A public university medical center and a private university medical center.

Patients  Five men and 6 women (median age, 64 years) with nontraumatic perforation of the bile duct were treated between September 1993 and May 2003.

Interventions  Two patients with common bile duct (CBD) stones, who were initially diagnosed as having mediastinal abscess and subcapsular biloma, respectively, were treated by nonoperative management, ie, endoscopic sphincterotomy and percutaneous abscess drainage. The remaining 9 patients were treated surgically, which included an exploration of the CBD, placement of a T tube, and a liver resection.

Main Outcome Measures  Initial manifestation, primary disease, perforation site, management, surgical morbidity, and mortality.

Results  All patients had acute abdominal pain, which was caused by intraabdominal abscess in 7 patients, diffuse bile peritonitis in 3, and subcapsular biloma in 1. Their primary diseases were CBD stones in 7 patients, intrahepatic duct stone in 2, a choledochal cyst in 1, and phytobezoar with food stuff in the CBD in 1. Perforations occurred at the left intrahepatic duct in 9 patients, the CBD in 1, and the cyst wall in 1. All patients recovered, except 1 patient who expired owing to multiorgan failure because the operation could not be performed in time.

Conclusions  Nontraumatic perforation of the bile duct should be suspected if perihepatic abscess or peritonitis is combined with biliary stone disease. The management of nontraumatic perforation of the bile duct should include the eradication of the primary pathologic lesion and the control of abscess or peritonitis.

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