SPONTANEOUS PERFORATION OF CHOLEDOCHAL CYST - A STUDY OF 13 CASES

Of the 187 cases of infantile choledochal cyst treated at our hospital s, we encountered 13 with spontaneous perforation. All Eases were unde r 4 years old. Eight cases were found to have biliary peritonitis and 5 had a sealed perforation. The shape of the extrahepatic bile duct wa s cystic in 8 and fusiform in 5. The cyst wall around the perforation was filmy and bile was found to be oozing through the thinned wall. Ni ne perforations were single while 4 cases had multiple perforations. F our of 17 perforations occurred in the posterior part of the cyst wall . Only 1 case of perforation was associated with protein plugs in a co mmon channel, while 7 of the 10 cases of choledochal cyst requiring pe rcutaneous biliary drainage due to signs of raised intrabiliary pressu re were found to have protein plugs. We consider that spontaneous perf oration of a choledochal cyst is not rare in infancy. The etiology of a perforation must be epithelial irritation of the biliary tract due t o refluxed pancreatic juice caused by pancreatico-biliary malunion ass ociated with mural immaturity due to infancy, rather than an abnormal rise in ductal pressure or congenital mural weakness at a certain poin t.