A rare cause of bile duct rupture

Excerpt

Rupture of the biliary tree is usually secondary to hepatobiliary surgery, instrumentation, or abdominal trauma. This 68-year-old lady with no previous medical history presented with pain, vomiting, abdominal distension, and breathlessness of 10 days. She had a large tender lump in the right hypochondrium. Liver function tests were normal and ultrasound showed cholelithiasis and choledocholithiasis along with subcapsular fluid collection in the right lobe of the liver. Contrast-enhanced computed tomography revealed a massive subcapsular collection in the right lobe (Fig. 1). She was treated with antibiotics, percutaneous drainage of the collection, and stenting of the common bile duct. Imaging revealed also a cutoff of the right biliary system (extrinsic compression) with a normal left biliary system (Fig. 2). She underwent cholecystectomy. Fujiwara et al. in 1998 [1] analyzed 25 cases of spontaneous bile duct rupture and found them to be related to choledocholithiasis, acute cholecystitis, hepatic infarction, liver abscess, sickle cell disease, and tuberculosis. Endoscopic retrograde cholangiopancreatography (ERCP) and stenting is indicated to locate any ongoing leak and bridge the defect or decrease resistance [2].

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