Spontaneous Perforation of a Choledochal Cyst, Clues for Diagnosis

Aim: Spontaneous perforation is a rare complication of a choledochal cyst that is difficult to diagnose because of its nonspecific clinical presentation. These patients usually present with an insidious course characterized by progressive abdominal distension, vomiting, and pain. Here, we present a series of three cases for clues for diagnosis.Materials and methods: All patients with spontaneous perforation of a choledochal cyst who were presented to our institute from January 2009 to December 2011 were included in the study and symptoms and signs at the time of presentation were analyzed.Results: All patients had clinical jaundice and acholic stools at the time of presentation; pain and vomiting was not a consistent feature. Abdominal paracentesis helped us diagnose these cases.Conclusion: Abdominal paracentesis is very useful in cases of suspected spontaneous perforation of the bile duct. Simple drainage with a T-tube, if possible, is safe, efficacious, has low morbidity, and aids in the establishment of the diagnosis as well as delineation of the anatomy of the concerned region for definitive surgery.Keywords: Choledochal Cyst, Spontaneous Perforation of Bile Duct, T-tub