Abstract:
Spontaneous rupture of the biliary duct, a rare condition in adults, is difficult to diagnose
preoperatively and presents with acute abdominal symptoms. The treatment ofthis rare condition should
be based on the individual’s clinical status. We present peripheric biliary duct rupture (segment three)
treated with external segment III drainage and postoperative endoscopic removal of the stones.
An 82-year-old male patient presented with abdominal pain and fever. An ultrasound
(US) revealed a solid gall stone lesion, 3 cm in diameter, in liver segments three and four with
additional intra-abdominal fluid accumulation without coexisting free air. A diagnostic laparotomy was
then performed because the patient had signs of peritonitis. Exploration revealed a biliary leakage from
the posterior surface of segment three. An external biliary drainage catheter was inserted to the perforated
segment III duct via a 6 French (6F) feeding catheter. He was discharged after 10 days and
his intracholedocal stent was removed postoperative after three months. The patient continues to be
monitored.
DISCUSSION: Spontaneous rupture ofthe intrahepatic biliary ductis a rare condition. Although occurrence
is frequently reported as spontaneous, the majority of cases are related to choledocholithiasis. The role
of surgical treatment in cases of spontaneous bile duct rupture is unclear. When biliary peritonitis is
present, drainage of contaminated biliary fluid, T-tube drainage, closure of the biliary duct, as well as
primary disease conditions, should be reviewed prior to treatment.
Surgical treatment of spontaneous biliary duct rupture should be indicated only after
careful consideration of the patient’s clinical and comorbidity status.
