Case Report: Spontaneous perforation of choledochal cyst in an infant: Successful management in a centre with limited means

Abstract

Background: Biliary peritonitis due to a ruptured choledochal cyst (CC) is a rare occurrence. The difference between bile duct perforation (BDP) and ruptured choledochal cysts continues to be a matter of debate. Simple drainage, T tube placement and cholecystostomy have been proposed as the initial treatment of choice. Definitive surgery in the form excision of the CC and hepatico-enterostomy has been described as the ideal treatment option. We report a successful management of a unique case of perforated choledochal cyst in an infant who presented with biliary peritonitis. Case report: An 8 months old female child presented with biliary peritonitis as result of spontaneous perforation of a choledochal cyst. The patient was successfully managed initially by placement of T tube in the perforated cyst followed by a T tube cholangiogram. Definitive surgery was performed 5 weeks after the initial surgery in which cyst was excised and hepatico-duodenostomy was performed. The child is currently in follow up and doing well. Conclusion: Perforated CC can present as acute abdomen sometimes having only subtle signs. In absence of any previous established diagnosis of CC and trained radiological support the condition becomes challenging to diagnose preoperatively. External T-tube drainage followed by T-tube cholangiogram can help in delineating the anatomy. Cyst excision along with hepaticoportoentersomy remains the gold standard definitive treatment.