Spontaneous Perforation of the Cystic Duct in Adults—Report of a Case

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 81; no. 3; pp. 554 - 558
• Main Authors: OKA, Tomo, YAGI, Masayuki
• Format: Journal Article
• Language: Japanese; English
• Published: Japan Surgical Association 2020
• Subjects: cystic duct; pancreatitis; perforated bile duct
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.81.554

Spontaneous perforation of the bile duct can be associated with congenital biliary dilatation in childhood, and is rare in adults. On the other hand, spontaneous cystic duct perforation has been reported in only a few cases to date. A 63-year-old woman was referred to our hospital complaining of right lower abdominal pain, and abdominal CT revealed localized ascites. At first, we started the patient on treatment for acute pancreatitis, based on the finding of elevated serum amylase levels. However, thereafter, because of the increasing abdominal ascites and unclear findings on the abdominal CT of acute pancreatitis, we performed exploratory laparoscopy. The laparoscopic exploration revealed intraperitoneal bile and a necrotic area in the hepatoduodenal ligament. The surgery was converted to laparotomy, and cholecystectomy and extrahepatic bile duct resection, including the necrotic part, and hepaticojejunostomy were performed. Finally, we found that the necrotic part was in the cystic duct, with a low junction of the common bile duct (intra- pancreatic junction). The patient had an uneventful postoperative course and was discharged after the surgery. Histopathology of the resected specimen indicated acute inflammatory cell infiltration of mainly the serosal side at the perforated part of the cystic duct, and the possibility of diverticulitis in the area and exterior influences such as pancreatitis was considered.