Department of General Surgery, Amiri Medical Complex, Qargha Road, Afshar, Kabul, Afghanistan.
Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, 410011, China.
BMC Surg. 2021 May 8;21(1):239. doi: 10.1186/s12893-021-01230-2.
Spontaneous biliary system perforation is a rare presentation in clinical practice especially in adults. It is rarely suspected and diagnosed preoperatively due to small number of cases, vague sign and symptoms, and ambiguous presentation.
We describe an interesting case of spontaneous perforation of the common bile duct in a 16 year-old female who presented a week after her first birth to the emergency department with complaints of diffuse abdominal pain, abdominal distention, fever, vomiting, and constipation. She was having generalized peritonitis but the etiology was unclear despite a thorough workup. She underwent exploratory laparotomy, and a perforation in the supra duodenal region of the common bile duct was found intraoperatively. The common bile duct was repaired over T-tube, and cholecystectomy was performed; the patient was recovered uneventfully.
Spontaneous biliary perforation is a rare cause of acute abdomen in adults and extremely rare in pregnancy. Its delayed diagnoses and management can lead to a high morbidity and mortality. All physicians, especially surgeons, should be aware of this possibility and consider it a cause of peritonitis on differential diagnosis particularly when there is no apparent etiology available for presentation.
自发性胆道系统穿孔在临床实践中较为罕见，尤其在成人中更为少见。由于病例数量较少、症状和体征不明显以及表现不明确，术前很少怀疑和诊断。
我们描述了一个 16 岁女性的有趣病例，她在首次分娩一周后因弥漫性腹痛、腹胀、发热、呕吐和便秘到急诊科就诊。她患有弥漫性腹膜炎，但尽管进行了全面检查，病因仍不清楚。她接受了剖腹探查术，术中发现胆总管十二指肠上段穿孔。胆总管在 T 管上修复，并进行胆囊切除术；患者恢复顺利。
自发性胆道穿孔是成人急性腹痛的罕见原因，在妊娠中极为罕见。其延迟诊断和治疗可导致高发病率和死亡率。所有医生，尤其是外科医生，都应该意识到这种可能性，并在鉴别诊断中考虑将其作为腹膜炎的原因，特别是当没有明显病因可用于表现时。
