Spontaneous perforation of the right hepatic duct.

Spontaneous perforation of the biliary ductal system is a rare cause of peritonitis with a high morbidity and mortality rate. We present a case of an 80-year-old female who presented to the Emergency Department with acute onset abdominal pain and peritoneal signs. She was taken to the operating room for exploratory laparotomy and discovered to have a perforation of her right hepatic duct. Several risk factors were found to play a role in her biliary perforation: biliary calculi, infection, and vessel thrombosis. She underwent a cholecystectomy, choledochotomy with removal of gallstones, repair of the perforation, and placement of a T-tube. She had a prolonged recovery in the intensive care unit and was eventually discharged to a skilled nursing facility. We conclude that the management of this unique and highly fatal disease can be applied with an excellent outcome.