Laparoscopic Management of a Rare Case of Spontaneous Biliary Perforation in an Infant

Abstract

Spontaneous biliary perforation is a rare condition, predominantly observed in infants, characterized by the leakage of bile into the peritoneal cavity without any apparent cause. This case report discusses a 3-month-old female infant who presented with symptoms of jaundice and abdominal distension. The successful management of this case with a combination of ultrasound-guided percutaneous drainage and laparoscopic cholecystostomy is detailed, highlighting the importance of minimally invasive techniques in treating this condition.

Keywords: Cholecystostomy; infant; jaundice; laparoscopy; spontaneous biliary perforation.

Figure 1

(a) Magnetic resonance cholangiopancreatography image showing the large cystic collection in the subhepatic region (star), with only the common hepatic duct (CHD) and intrahepatic biliary radicals (IHBR) visible above it (arrow) (b) Laparoscopy port positions with 5 mm port at the umbilicus and 3 mm ports in right and left upper quadrant (c) Intraoperative contrast study image performed through the percutaneous drainage initially filled up a large pseudocyst-like cavity (star) which then filled up and revealed a dilated CHD (arrow), mild IHBR dilatation, gallbladder (GB), and distal common bile duct (d) Laparoscopy image showing insertion of 8 Fr Foley catheter as cholecystostomy tube in GB with a purse-string suture tied around the GB entry point with hitch sutures to the parietes at 3 points

Figure 2

(a) Cholangiogram done through the cholecystostomy on postoperative day 7 which revealed a well-opacified, mildly dilated biliary tree with dye flowing into the duodenum with some contrast extravasation into the pseudocyst bilioma cavity (star) (b) Repeat cholangiogram done through the cholecystostomy at 3 weeks postoperative showing mildly dilated biliary tree with dye flowing freely into the duodenum with no contrast extravasation into the bilioma cavity