Howard E R, Johnston D I, Mowat A P
Arch Dis Child. 1976 Nov;51(11):883-6. doi: 10.1136/adc.51.11.883.
Two infants with spontaneous perforation of the common bile duct are described. One presented with mild jaundice, dark urine, acholic stools, and hydroceles, the other with bilateral inguinal hernia. In both the diagnosis was unsuspected until bile-stained ascites was discovered. Both eventually developed bile-staining of the scrotum. Neither was acutely ill. The 131I-Rose Bengal faecal excretion test showed reduced faecal excretion at 8% and 12% of the injected dose with 16-5 and 17%/dl of the dose being recovered in the ascitic fluid 48 hours after intravenous injection. The ascitic:plasma ratio of isotope at that time was 32:1 and 28:1. Operative cholangiography in both showed a perforation at the junction of the cystic duct and common bile duct with no contrast entering the duodenum. Cholecystenterostomy using a Roux-en-Y loop of jejunum produced a rapid sustained recovery and is suggested as the treatment of choice. This condition should be considered in the differential diagnosis of obstructive jaundice in infancy since early surgical correction is necessary.
本文描述了两名胆总管自发性穿孔的婴儿。一名婴儿表现为轻度黄疸、深色尿液、无胆汁粪便和鞘膜积液，另一名婴儿表现为双侧腹股沟疝。在发现胆汁染色的腹水之前，两名婴儿的诊断均未被怀疑。两人最终都出现了阴囊胆汁染色。两人均无急性病状。131I-玫瑰红粪便排泄试验显示，粪便排泄减少，分别为注射剂量的8%和12%，静脉注射48小时后，腹水中分别回收了16.5%和17%的注射剂量。此时腹水与血浆的同位素比值分别为32:1和28:1。两人的手术胆管造影均显示胆囊管与胆总管交界处穿孔，无造影剂进入十二指肠。使用空肠Roux-en-Y袢进行胆囊肠吻合术可实现快速持续恢复，建议作为首选治疗方法。由于需要早期手术矫正，在婴儿期梗阻性黄疸的鉴别诊断中应考虑这种情况。
