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. 1976 Nov;51(11):883–886. doi: 10.1136/adc.51.11.883

Spontaneous perforation of common bile duct in infants.

E R Howard, D I Johnston, A P Mowat
PMCID: PMC1546053  PMID: 1008596

Abstract

Two infants with spontaneous perforation of the common bile duct are described. One presented with mild jaundice, dark urine, acholic stools, and hydroceles, the other with bilateral inguinal hernia. In both the diagnosis was unsuspected until bile-stained ascites was discovered. Both eventually developed bile-staining of the scrotum. Neither was acutely ill. The 131I-Rose Bengal faecal excretion test showed reduced faecal excretion at 8% and 12% of the injected dose with 16-5 and 17%/dl of the dose being recovered in the ascitic fluid 48 hours after intravenous injection. The ascitic:plasma ratio of isotope at that time was 32:1 and 28:1. Operative cholangiography in both showed a perforation at the junction of the cystic duct and common bile duct with no contrast entering the duodenum. Cholecystenterostomy using a Roux-en-Y loop of jejunum produced a rapid sustained recovery and is suggested as the treatment of choice. This condition should be considered in the differential diagnosis of obstructive jaundice in infancy since early surgical correction is necessary.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Cottrall K., Cook P. J., Mowat A. P. Neonatal hepatitis syndrome and alpha-1-antitrypsin deficiency: an epidemiological study in south-east England. Postgrad Med J. 1974 Jun;50(584):376–380. doi: 10.1136/pgmj.50.584.376. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. DeLorimier A. A. Surgical management of neonatal jaundice. N Engl J Med. 1973 Jun 14;288(24):1284–1286. doi: 10.1056/NEJM197306142882407. [DOI] [PubMed] [Google Scholar]
  3. HINDMARSH F. D. Bile peritonitis in infancy. Br Med J. 1947 Jul 26;2(4516):131–131. doi: 10.1136/bmj.2.4516.131. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Hansen R. C., Wasnich R. D., De Vries P. A., Sunshine P. Bile ascites in infancy: diagnosis with 131-I-rose bengal. J Pediatr. 1974 May;84(5):719–721. doi: 10.1016/s0022-3476(74)80015-6. [DOI] [PubMed] [Google Scholar]
  5. Lees W., Mitchell J. E. Bile peritonitis in infancy. Arch Dis Child. 1966 Apr;41(216):188–192. doi: 10.1136/adc.41.216.188. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Lilly J. R., Weintraub W. H., Altman R. P. Spontaneous perforation of the extrahepatic bile ducts and bile peritonitis in infancy. Surgery. 1974 May;75(5):664–673. [PubMed] [Google Scholar]
  7. Moore T. C. Massive bile pertonitis in infancy due to spontaneous bile duct perforation with portal vein occlusion. J Pediatr Surg. 1975 Aug;10(4):537–540. doi: 10.1016/0022-3468(75)90200-6. [DOI] [PubMed] [Google Scholar]
  8. Sass-Kortsak A. Management of young infants presenting with direct-reacting hyperbilirubinemia. Pediatr Clin North Am. 1974 Nov;21(4):777–799. doi: 10.1016/s0031-3955(16)33061-9. [DOI] [PubMed] [Google Scholar]
  9. Wynne J. M., Cywes S., Retief P. J., Louw J. H. Ascites in the newborn. S Afr Med J. 1968 Sep 14;42(35):919–925. [PubMed] [Google Scholar]

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