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Case report


Spontaneous biliary peritonitis in children.

Supreethi KohliAnu SinghalAnita AroraSanjeev Singhal
Departments of Radiology, Pediatrics, Employees State Insurance Model Hospital and Postgraduate Institute of Medical Sciences and Research, Department of Surgery, Northern Railway Central Hospital, New Delhi, India
Date of Submission: 31-Mar-2013, Date of Acceptance: 08-May-2013, Date of Web Publication: 29-Jun-2013.
Corresponding Author:
Corresponding Author

Anu Singhal

244/2d, Railway Officers’ Enclave, Panchkuian Road, New Delhi ‑ 110 001, India.
E-mail: drsinghals@gmail.com

Corresponding Author:
Corresponding Author

Anu Singhal

244/2d, Railway Officers’ Enclave, Panchkuian Road, New Delhi ‑ 110 001, India.
E-mail: drsinghals@gmail.com

DOI: 10.4103/2156-7514.114213 Facebook Twitter Google Linkedin

ABSTRACT


Pediatric Spontaneous Bile duct perforation is a rare clinical condition with only around 150 cases reported worldwide. Early management gives excellent prognosis but the condition often presents a diagnostic dilemma. Hepato-biliary Technetium-99m-iminodiacetic acid scintiscan is the diagnostic investigation of choice but its availability in third world countries is limited. We present two cases of spontaneous biliary peritonitis in children, which were diagnosed without scintiscanning. The first case was a one-and -a half-year-old child, who was diagnosed with biliary peritonitis without pneumoperitoneum by a combination of Ultrasound (USG), Contrast enhanced computed tomography (CECT), and Magnetic Resonance Imaging (MRI). The child underwent USG-guided drainage and subsequent cholecystectomy with hepatico-jejunostomy. The second child also had biliary peritonitis without pneumoperitoneum, which was initially suspected on USG. CECT revealed dilated gall bladder and fluid collection in sub-hepatic space and pelvis. Abdominal paracentesis revealed presence of bile. The child responded to conservative therapy. Both are doing well on two-year follow-up. In a patient with jaundice, biliary tract abnormalities and/or free fluid, either generalized or localized to peri-cholecystic/sub-hepatic space on USG/CT/MRI, in the absence of pneumoperitoneum, suggest a diagnosis of biliary perforation even in the absence of scintiscanning.
Keywords: Biliary Peritonitis, Conjugated Hyperbilirubinemia, Spontaneous Biliary Perforation, Ultrasound

Cited in 2 Documents

  1. Rahul Gupta, Rozy Paul, Sanjay Sharma, Shyam Bihari Sharma and Praveen Mathur (2015) Spontaneous biliary perforation in a 7-year-old child. Formosan Journal of Surgery 48(4):133. doi: 10.1016/j.fjs.2015.03.001
  2. F. Badru, T. Litton, Y. Puckett, S. Bansal, M. Guzman, D. Vane and G. A. Villalona (2016) Spontaneous gallbladder perforation in a child secondary to a gallbladder cyst: a rare presentation and review of literature. Pediatr Surg Int 32(6):629. doi: 10.1007/s00383-016-3891-4

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