Spontaneous perforation of bile ducts.

The rarity of spontaneous perforation of bile ducts in the absence of trauma or previous biliary surgery is apparent by the few reports in the literature. In a review of the available literature, only 23 perforations of the common duct and 10 perforations of the common hepatic duct were found. This report adds two cases--one occurring in the distal common hepatic duct and one in a small superficial hepatic duct radical on the inferior surface of the liver. Choledochal calculi associated with infected bile and increased pressure in the proximal ductal system are the most common etiologic factors in spontaneous perforation of biliary ducts. Free bile or bile stained fluid in the peritoneal cavity with an intact gallbladder should alert the surgeon to the possibility of bile duct perforation. Recognition and proper surgical treatment as outlined are essential for successful management of this rare occurrence.