Spontaneous Perforation of Extra Hepatic Bile Duct in a Child

Spontaneous perforation of biliary tree is rare. It mostly occurs in infants. Most cases are associated with biliary stone or other factors related to the bile flow. We report a case in six-year-old girl, hailing from eastern part of India, with SBP without any predisposition. She presented with acute abdomen for three days. Investigations revealed free fluid in abdomen but no free gas under diaphragm. An exploratory laparotomy showed perforation at the supraduodenal portion of common bile duct. No stone/stricture or any other apparent cause of the perforation was found. It was repaired over T-tube and abdomen was drained. Postoperatively the patient made an uneventful recovery. T-tube cholangiogram done on day fourteen was normal and the tube was removed. At one year, the patient is doing well. We include a review of the literature with emphasis on the management of this rare condition.