Spontaneous bile duct perforation causing biliary peritonitis in chronic pancreatitis

Spontaneous bile duct perforation causing biliary peritonitis in chronic pancreatitis

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Spontaneous perforation of the extrahepatic biliary system is a rare presentation of chronic pancreatitis.Very few cases of bile duct perforation have been reported in adults.It is rarely correctly diagnosed preoperatively in an emergency.

A 25-year-old male presented click here at the surgical emergency with a long history of abdominal pain and repeated episodes of vomiting, after 4 days of duration, he came with pain abdomen, and distension with evidence of generalized peritonitis.The diagnosis made was perforative peritonitis for which he underwent an exploratory laparotomy with cholecystectomy.A single perforation was presented on the anterolateral surface of the supraduodenal part of the common bile duct (CBD) which was repaired with the help of T-tube.

On the 10th post-operative day, T-tube cholangiogram shows two radio-opaque dense shadows in the main pancreatic duct which shows chronic pancreatitis and lower CBD stricture.Spontaneous perforation of the extrahepatic bile duct is a rare but important presentation of chronic pancreatitis in adults causing biliary peritonitis.Therefore, awareness of the clinical presentation, expert ultrasound examination, and surgery are important color touch 7/97 aspects of the management.