750 An Unusual Presentation of a Rare Clinical Entity – A Case Report of Spontaneous Common Bile Duct Perforation in an Adult

Abstract Spontaneous or non-traumatic perforation of the extrahepatic biliary system is a rare clinical phenomenon, with few cases reported since its first mention in medical literature by Freeland 1882. Given rarity, misdiagnosis common diagnosis almost always made during urgent exploratory laparotomy. We describe case spontaneous bile duct (CBD) an 83-year-old female no associative underlying disease process identified. The patient presented sudden onset abdominal pain identifiable trigger, minimal past history. Examination was remarkable for findings epigastric tenderness and guarding. Haematological investigation only hyperamylasaemia leucocytosis. Pneumoperitoneum ruled out following contrast CT abdomen pelvis working mild pancreatitis made. US Abdomen MRCP found evidence cholelithiasis, dilatation. continued to deteriorate on ward, aspiration new intrabdominal fluid collection raising suspicion perforated viscus. Exploratory laparotomy revealed 1-cm defect CBD frank leak. A T-tube placed defect, robertson drain also inserted. No further leak identified via Tubogram, successfully discharged multidisciplinary rehabilitation intensive care ward setting. Surgeons should seek this uncommon patients suspected cholelithiasis who do not conform normal biliary/pancreatic progression patterns.