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Case Reports
. 2011 Jan;17(1):CS8-11.
doi: 10.12659/msm.881317.

T tube drainage for spontaneous perforation of the extrahepatic bile duct

Satoshi Mizutani  1 , Aki Yagi, Masanori Watanabe, Kentaro Maejima, Osamu Komine, Masanori Yoshino, Masao Ogata, Arichika Hoshino, Hideyuki Suzuki, Akira Tokunaga, Eiji Uchida
Affiliations
Case Reports

T tube drainage for spontaneous perforation of the extrahepatic bile duct

Satoshi Mizutani et al. Med Sci Monit. 2011 Jan.

Abstract

Background: Spontaneous perforation of the extrahepatic bile duct is very rare. We report a patient with a spontaneous perforation of the left hepatic bile duct who was diagnosed preoperatively.

Case report: A 65-year-old woman was admitted to our hospital complaining of a right upper quadrant pain lasting for two days. She was diagnosed as having a perforated bile duct and peritonitis and underwent a laparotomy. After a cholecystectomy, T-tube drainage of the left hepatic duct was performed. The postoperative course was uneventful. The T tube was removed 25 days after the surgery.

Conclusions: A more noninvasive procedure, such as endoscopic treatment, should play a central role in the management of extra bile duct perforation. For this case, however, we chose to perform a laparotomy based on the patient's general condition and the presence of peritonitis. T tube decompression is effective and a safe and reliable method. The goal of treatment is to stop the bile leakage, resolve the choledocholithiasis and cholangitis, and reconstruct the bile duct.

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Figures

Figure 1
Figure 1
(A) A calculus deviated from the hepatoduodenal ligament was recognized in the right upper peritoneal space (arrow). The wall of the gallbladder (GB) shows evidence of thickening. No GB stones are visible. (B) A small amount of ascites has accumulated in Morison’ pouch. Several calculi similar to the deviated calculus are visible in the common bile duct (arrow).
Figure 2
Figure 2
(A) The arrow indicates the hole in the anterior wall of the bile duct. The hepatoduodenal ligament became friable because of an infection. (B) The calculi were grasped with forceps and removed carefully. (C) A T tube was inserted from the perforated site, and a cholangiography was performed using a low pressure.
Figure 3
Figure 3
(A) Intraoperative cholangiography shows the perforation in the left hepatic duct; no calculi remain in the bile duct. No other perforations or stenosis in Calot’ triangle were observed. (B) Magnetic resonance cholangiopancreatography examination performed 1 year after surgery shows a healthy bile duct with no signs of stenosis or dilatation.
See this image and copyright information in PMC

References

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