Nontraumatic Perforation of the Bile Duct in Adults | Hepatobiliary Disease | JAMA Surgery | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Ando  H, Ito  T, Watanabe  Y, Seo  T, Kaneko  K, Nagaya  M.  Spontaneous perforation of choledochal cyst.  J Am Coll Surg. 1995;181:125-128. PubMedGoogle Scholar
Ando  K, Miyano  T, Kohno  S, Takamizawa  S, Lane  G.  Spontaneous perforation of choledochal cyst: a study of 13 cases.  Eur J Pediatr Surg. 1998;8:23-25. PubMedGoogle ScholarCrossref
Xanthakos  SA, Yazigi  NA, Ryckman  FC, Arkovitz  MS.  Spontaneous perforation of the bile duct in infancy: a rare but important cause of irritability and abdominal distension.  J Pediatr Gastroenterol Nutr. 2003;36:287-291. PubMedGoogle ScholarCrossref
Paladugu  R, Rau  A, Schein  M, Wise  L.  Spontaneous perforation of the hepatic duct in adults.  Dig Surg. 1998;15:417-420. PubMedGoogle ScholarCrossref
Nguyen  WD, Daza  E.  Spontaneous perforation of the right hepatic duct.  Hepatogastroenterology. 2001;48:1028-1029. PubMedGoogle Scholar
Suarez  L, Detmer  DE, Jarrett  F.  Surgical management of spontaneous hepatic duct perforations.  Ann Surg. 1981;194:176-179. PubMedGoogle ScholarCrossref
Howard  ER, Johnston  DI, Mowat  AP.  Spontaneous perforation of common bile duct in infants.  Arch Dis Child. 1976;51:883-886. PubMedGoogle ScholarCrossref
Dunn  DC, Lees  VC.  Spontaneous perforation of the common bile duct in infancy.  Br J Surg. 1986;73:929. PubMedGoogle ScholarCrossref
Johnston  JH.  Spontaneous perforation of the common bile duct in infancy.  Br J Surg. 1961;48:532-533.Google ScholarCrossref
Lilly  JR, Weintraub  WH, Altman  RP.  Spontaneous perforation of the extrahepatic bile ducts and bile peritonitis in infancy.  Surgery. 1974;75:664-673. PubMedGoogle Scholar
Megison  SM, Votteler  TP.  Management of common bile duct obstruction associated with spontaneous perforation of the biliary tree.  Surgery. 1992;111:237-239. PubMedGoogle Scholar
Moore  TC.  Massive bile peritonitis in infancy due to spontaneous bile duct perforation with portal vein occlusion.  J Pediatr Surg. 1975;10:537-540. PubMedGoogle ScholarCrossref
Ng  WT.  "Spontaneous" perforation of the common bile duct.  Surgery. 1999;126:99-100. PubMedGoogle ScholarCrossref
Hill  NS, Colapinto  ND.  Spontaneous perforation of the common bile duct.  Br J Surg. 1981;68:661-662. PubMedGoogle ScholarCrossref
Kumar  A.  Spontaneous perforation of the common bile duct: a rare cause of acute abdomen in adults.  Surgery. 1998;124:924-925. PubMedGoogle ScholarCrossref
Colver  HD.  Perforation of the biliary tract due to gallstones in infancy: an established clinical entity.  Ann Surg. 1964;160:226-231. PubMedGoogle ScholarCrossref
Freeland  J.  Rupture of the hepatic duct.  Lancet. 1882;1:731-732.Google ScholarCrossref
Chu  CS.  Spontaneous perforation of the common hepatic duct: report of seven cases.  Surg Gastroenterol. 1984;3:69-76. PubMedGoogle Scholar
Rivilla  F.  Idiopathic perforation of the extrahepatic bile duct in infancy: pathogenesis, diagnosis, and management.  J Pediatr Surg. 1994;29:955-956. PubMedGoogle ScholarCrossref
Jackson  BT, Saunders  P.  Perforated choledochus cyst.  Br J Surg. 1971;58:38-42. PubMedGoogle ScholarCrossref
Ohkawa  H, Takahashi  H, Maie  M.  A malformation of the pancreatico-biliary system as a cause of perforation of the biliary tract in childhood.  J Pediatr Surg. 1977;12:541-546. PubMedGoogle ScholarCrossref
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

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.