Spontaneous perforation of the bile duct in infants: a case report

Spontaneous perforation of the bile duct is a rare disease in children. To date, less than a hundred cases have been reported in English literature. A number of techniques have been applied to achieve preoperative diagnosis yet most cases are diagnosed at operation. A 3-month-old girl presented with fever, vomiting, progressive abdominal distension, jaundice and diarrhoea. Abdominal ultrasonography showed localized collection of fluid that displaced the small bowel to the right side of the abdomen. The fluid was found to be bilious on paracentesis. At laparotomy, biliary pseudocyst was found but the site of perforation was no longer identifiable. Excision of the containing wall and external drainage was carried out. 9 months after operation the child is well. A high index of suspicion should improve diagnosis and ensure early intervention