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258 NONTRAUMATIC SPONTANEOUS PERFORATION OF BILE DUCTS IN ADULTS: CASE REPORT AND REVIEW OF LITERATURE R Abdalian, S Grover, O Al-Harbi, G May Bile duct perforation has been a well-recognized complication of invasive open or laparoscopic surgical interventions. Nontraumatic spontaneous bile duct perforation however is a rare entity that occurs without prior trauma or iatrogenic injury. We report the case of a 76 year-old man who presented with fever and acute abdomen. Exploratory laparotomy revealed a large amount of bile within peritoneum with no evidence of cholecystitis, biliary stones or culprit duct perforation site. A subsequent endoscopic retrograde cholangiography identified a leak from a peripheral duct of the right hepatic system that was successfully treated endoscopically. Nontraumatic perforation is a rare albeit recognized occurrence previously reported in the cystic and common bile ducts mainly in association with choledocholithiasis. Our case is a first depiction of spontaneous intrahepatic bile duct perforation in the absence of trauma, iatrogenic injury or stones. A review of the literature and speculations on etiopathogenesis are offered.
Department of Gastroenterology, St Michael's Hospital, Toronto, Ontario