Lloyd D A, Mickel R E
Br J Surg. 1980 Sep;67(9):621-3. doi: 10.1002/bjs.1800670905.
Biliary ascites due to "spontaneous" perforation of the extra-hepatic bile ducts is uncommon, and should be suspected in an infant who, after a period of good health, develops jaundice and progressive abdominal distension. When the presentation is acute without jaundice the diagnosis is unlikely to be considered unless paracentesis is performed. The perforation is typically located in the common bile duct near its junction with the cystic duct and simple peritoneal drainage without suture is recommended unless the bile duct is obstructed, in which case T tube drainage or a bypass procedure is required. The prognosis is good. Four patients are presented who illustrate the spectrum of clinical presentation and the different methods of management. Two patients in whom the perforation was in the cystic duct were successfully treated by cholecystectomy. In most cases the aetiology is not apparent, but important factors may be weakening of the common bile duct wall due to ischaemia or pancreatic juice, reflux, associated with a rise in choledochal pressure. In older children the onset of biliary ascites may be preceded by an acute gastrointestinal illness, which may be a predisposing factor.
肝外胆管“自发性”穿孔所致胆汁性腹水并不常见，对于健康一段时间后出现黄疸和进行性腹胀的婴儿应怀疑此病。当表现为无黄疸的急性症状时，除非进行腹腔穿刺术，否则不太可能考虑该诊断。穿孔通常位于胆总管与胆囊管交界处附近，除非胆管阻塞，一般建议采用单纯腹腔引流而不缝合，胆管阻塞时则需要进行T管引流或旁路手术。预后良好。本文介绍了4例患者，以说明临床表现范围和不同的治疗方法。2例穿孔位于胆囊管的患者通过胆囊切除术成功治愈。在大多数情况下，病因并不明显，但重要因素可能是由于缺血或胰液反流导致胆总管壁变弱，同时胆总管压力升高。在大龄儿童中，胆汁性腹水的发作可能先于急性胃肠道疾病，这可能是一个诱发因素。
