BILE PERITONITIS DUE TO A SPONTANEOUS PERFORATION OF THE COMMON BILE-DUCT - REPORT OF A CASE

Spontaneous perforation of the extrahepatic bile duct is rare. We here in report the case of an 80-year-old woman mho underwent emergency lap arotomy for bile peritonitis due to a spontaneous perforation of the c ommon bile duct. A 2-mm perforation mas found in the posterior wall of the choledochus, and its wall was paper-thin, Three stones, 2mm in di ameter, were removed from the common bile duct, She underwent T-tube d ecompression,vith intraoperative cholangiography demonstrating a swoll en papilla of Vater. The smelling of the papilla disappeared 4 weeks a fter the operation. Her postoperative course was uneventful, It seems likely that the elevated intraductal pressure due to the swollen papil la following stone impaction caused the perforation in this patient, F urthermore, the excessive friability of the common bile duct of unknow n etiology may also have contributed to the perforation, This experien ce along with a review of the literature indicate that biliary decompr ession is the treatment of choice for this condition.