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T tube drainage for spontaneous perforation of the extrahepatic bile duct

Satoshi Mizutani, Aki Yagi, Masanori Watanabe, Kentaro Maejima, Osamu Komine, Masanori Yoshino, Arichika Hoshino, Masao Ogata, Hideyuki Suzuki, Akira Tokunaga, Eiji Uchida

Med Sci Monit 2011; 17(1): CS8-11

DOI: 10.12659/MSM.881317

Background:    Spontaneous perforation of the extrahepatic bile duct is very rare. We report a patient with a spontaneous perforation of the left hepatic bile duct who was diagnosed preoperatively.
    Case Report:    A 65-year-old woman was admitted to our hospital complaining of a right upper quadrant pain lasting for two days. She was diagnosed as having a perforated bile duct and peritonitis and underwent a laparotomy. After a cholecystectomy, T-tube drainage of the left hepatic duct was performed. The postoperative course was uneventful. The T tube was removed 25 days after the surgery.
    Conclusions:    A more noninvasive procedure, such as endoscopic treatment, should play a central role in the management of extra bile duct perforation. For this case, however, we chose to perform a laparotomy based on the patient’s general condition and the presence of peritonitis. T tube decompression is effective and a safe and reliable method. The goal of treatment is to stop the bile leakage, resolve the choledocholithiasis and cholangitis, and reconstruct the bile duct.

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