Spontaneous Perforation of the Common Bile Duct in a Toddler: A Diagnostic Dilemma

Abstract

Spontaneous perforation of common bile duct (SPBD) is very rare but potentially fatal disorder. It is an unusual cause of acute abdomen. It is rarely suspected or correctly diagnosed preoperatively. Clinical presentation is as biliary peritonitis. The aetiology of SPBD is unknown, but proposed theories include congenital mural weakness of the common bile duct, ischaemia, distal biliary obstruction and pancreaticobiliary malunion, infection, and trauma. Bilious abdominal paracentesis, signs of peritonitis and absent free gas in abdominal x- ray will help to confirm the diagnosis. Preoperative recognition is necessary as early surgical intervention gives excellent prognosis. We report an interesting case of SPBD in a 4 years male child who presented to us as an acute abdomen. The literature has been reviewed with emphasis on the diagnostic dilemma of this rare condition. The treatment is surgical and consists of exploration and repair over a T-tube.