Biliary peritonitis due to choledochal cyst presenting in late pregnancy.

A previously healthy 23-year-old primigravida at 35 weeks' gestation presented with ante-partum haemorrhage and evidence of placental abruptio on ultrasound scanning. Emergency Caesarean section was performed via a Pfannenstiel incision, and a healthy baby was delivered in good condition. The obstetrician noticed that the peritoneal cavity contained some free reactive fluid, and surgical assistance was requested. It was difficult to carry out a full investigative laparotomy through the Pfannenstiel incision, but the appendix appeared normal and the stomach, duodenum, gallbladder, and pancreas were all normal on palpation. The colon was dilated from the caecum to the splenic flexure. The appendix was removed and a caecostomy tube was inserted via the appendix stump, to deflate the colon. A peritoneal drain was inserted and the incision closed. Following this, her condition did not improve and she remained ill, with abnormal liver function tests, elevated temperature and signs of generalised peritonitis.