Biliary peritonitis secondary to spontaneous rupture of hepatic mesenchymal hamartoma.

This is a 77 year old female with no medical history who presented to the emergency room with 48 hours of right hypochondrium abdominal pain, associated to conjunctive jaundice. The blood test showed elevated bilirubin and C reactive protein test. CT scan revealed gallbladder hydrops, dilated left intrahepatic bile duct, common bile duct (CBD) of 8 mm and left hepatic lobe atrophy (Fig. 1). The patient was admitted with the diagnosis of mild cholangitis and started antibiotic therapy. Cholangio-MRI showed cholelithiasis, distal choledocholithiasis with bile duct dilatation, left hepatic lobe atrophy with a dilated segmental bile duct of chronic aspect, right hepatic hypertrophy and millimeter diffuse cystic lesions (Fig. 2). Suddenly, her condition deteriorated associated with a diffuse peritonitis. She underwent a right subcostal laparotomy on