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Atwez A, Augustine M, Nottingham JM. Non-traumatic perforation of common hepatic duct: Case report and review of literature HP. Int J Surg Case Rep. 2017;41:188-190doi: 10.1016/j.ijscr.2017.10.023.
Atwez, A., Augustine, M., & Nottingham, J. M. (2017). Non-traumatic perforation of common hepatic duct: Case report and review of literature HP. International journal of surgery case reports, 41188-190. https://doi.org/10.1016/j.ijscr.2017.10.023
Atwez, Abdelaziz, et al. "Non-traumatic perforation of common hepatic duct: Case report and review of literature HP." International journal of surgery case reports vol. 41 (2017): 188-190. doi: https://doi.org/10.1016/j.ijscr.2017.10.023
Atwez A, Augustine M, Nottingham JM. Non-traumatic perforation of common hepatic duct: Case report and review of literature HP. Int J Surg Case Rep. 2017;41:188-190. doi: 10.1016/j.ijscr.2017.10.023. Epub 2017 Oct 18. PMID: 29096340; PMCID: PMC5683887.
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Int J Surg Case Rep. 2017;41:188-190. doi: 10.1016/j.ijscr.2017.10.023. Epub 2017 Oct 18.

Non-traumatic perforation of common hepatic duct: Case report and review of literature HP.

International journal of surgery case reports

Abdelaziz Atwez, Matthew Augustine, James M Nottingham

Affiliations

  1. University of South Carolina, School of Medicine, Department of Surgery, Two Medical Park, suite 306 Columbia, SC 29203, USA. Electronic address: [email protected].
  2. University of South Carolina, School of Medicine, Department of Surgery, Two Medical Park, suite 306 Columbia, SC 29203, USA.

PMID: 29096340 PMCID: PMC5683887 DOI: 10.1016/j.ijscr.2017.10.023

Abstract

INTRODUCTION: Non-traumatic biliary perforation other than the gallbladder is extremely rare and most commonly seen in children in association with congenital biliary anomalies. We present a rare case of choledocholithiasis that progressed to spontaneous perforation of the common hepatic duct probably from ischemic necrosis caused by impaction of large biliary stones.

CASEREPORT: A 62-year-old female presented with diarrhea and jaundice. She was found to have two 2.5cm stones in the common hepatic duct. Stones could not be extracted by ERCP, and placement of biliary stent was done to restore patency. The patient was lost to follow up and returned after three months with a new onset of similar symptoms. At that time ERCP and a stent change were done without resolution of the symptoms. Patient then underwent an open exploration and was found to have a free perforation in the lateral aspect of the common hepatic duct just at the bifurcation of the right and left hepatic radicals. Through this perforation stones were both extracted and cholangiogram showed free flow with the distal biliary stent. The stent was nowhere near the site of perforation which appeared to be caused by pressure necrosis from the impacted stones.

CONCLUSION: Impacted stones in the biliary tree need to be extracted to avoid pressure necrosis and spontaneous perforation. ERCP and stent placement should be used only as temporizing measures to manage the acute obstructive phase. Definitive surgical intervention must follow initial biliary decompression to extract the impacted biliary stones and avoid complications.

Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Keywords: CHD; Case report; Choledocolithiasis; Common hepatic duct; Spontaneous perforation; Stone impaction

References

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