Megison S M, Votteler T P
Department of Surgery, University of Texas Southwestern Medical School, Dallas.
Surgery. 1992 Feb;111(2):237-9.
Spontaneous perforation of the extrahepatic biliary tree during infancy is an uncommon event. The cause of bile duct perforation is unclear, but one-quarter of reported cases have been associated with a stone or bile sludge obstructing the distal common bile duct. A 4-week-old girl had jaundice, and a DISIDA (99m technetium diisopropyl iminodiacetic acid) scan revealed perforation of the biliary tree. Exploratory surgery showed distal common bile duct obstruction with proximal perforation. No attempt was made to remove the obstructing lesion because of duct inflammation. Common bile duct obstruction persisted until week 5 after surgery when cholangiography revealed free flow of contrast into the duodenum through a common bile duct of normal caliber without a filling defect. In the presence of acute inflammation associated with perforation of the biliary tree, exploration of the common bile duct to relieve a distal obstruction could prove hazardous. Our case and a review of the literature suggest that the obstructing stone or sludge may pass spontaneously if managed expectantly.
婴儿期肝外胆管自发性穿孔是一种罕见事件。胆管穿孔的原因尚不清楚，但在已报告的病例中，有四分之一与远端胆总管结石或胆泥梗阻有关。一名4周大的女孩出现黄疸，99m锝二异丙基亚氨基二乙酸（DISIDA）扫描显示胆管穿孔。探查手术显示远端胆总管梗阻伴近端穿孔。由于胆管炎症，未尝试切除梗阻病变。胆总管梗阻一直持续到术后第5周，此时胆管造影显示造影剂通过管径正常且无充盈缺损的胆总管自由流入十二指肠。在存在与胆管穿孔相关的急性炎症时，探查胆总管以解除远端梗阻可能是危险的。我们的病例及文献回顾表明，如果采取保守治疗，梗阻性结石或胆泥可能会自行排出。
