Journal of Indira Gandhi Institute of Medical Sciences (Oct 2023)

Spontaneous bile duct perforation causing biliary peritonitis in chronic pancreatitis

  • Mukesh Kumar,
  • Sanjit Prasad,
  • Vivek Kumar Roy,
  • Lavudya Mahesh,
  • Krishna Gopal

DOI
https://doi.org/10.4103/jigims.jigims_16_22
Journal volume & issue
Vol. 9, no. 2
pp. 182 – 184

Abstract

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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 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 aspects of the management.

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