Bile duct perforation in children: is it truly spontaneous?

INTRODUCTION

Bile duct perforation (BDP) with resultant biliary ascites in children is a rare clinical condition. The aetiopathogenesis is still an enigma, with increasing evidence suggesting anomalous union of pancreaticobiliary ductal (AUPBD) system as the prime causative factor.

CLINICAL PICTURE: We report 2 cases of spontaneous perforation of the bile duct confirmed on histopathological examination as choledochal cyst, in a 6-month-old female child and a 4-year-old boy who presented with subtle clinical symptoms.

TREATMENT AND OUTCOME: Both patients were successfully managed by excision of the gall bladder and common bile duct and Roux-en- Y hepaticojejunostomy. This procedure was performed following initial cholecystostomy drainage in the second case.

CONCLUSIONS

From the available literature and experience with our patients, BDP is not merely spontaneous but may be related to AUPBD and choledochal cyst.