Spontaneous non-traumatic common bile duct perforation presented as an acute abdomen: a rare case report

Sneha Angadi, Vinod Biradar


The spontaneous perforation of the biliary tract (SPBT) is an extremely rare cause of peritonitis, which was first described by Freeland in 1882, to date only around 70 cases have been reported. Here we present a case of spontaneous perforation of the biliary tract, in a patient with choledocholithiasis. A 45 years old male presented to us with acute abdomen with raised amylase and lipase s/o pancreatitis, imaging showed acute on chronic pancreatitis with impacted distal lumen in situ common bile duct (CBD) calculi. Patient was planned for ERCP with CBD clearance after his acute episode subsides. Meanwhile patient developed rigidity, guarding and distension. His second CECT showed a breach in the lower lateral segment in the CBD with gross ascites. Patient was planned for laparotomy, abdominal lavage and T-tube drainage. Patient had a stormy postoperative course. Patient recovered well and was discharged with T-tube clamped and subhepatic drain in situ. Spontaneous perforation of the extrahepatic bile duct is a rare but important presentation of gall stones. Conservative surgery that is decompression of the biliary tree and repair of the leak site over T-tube is the mainstay of treatment in the acute presentation.


Bile duct, Common bile duct, Peritonitis, Perforation, T-tube

Full Text:



Ambergera M, Burtonb N. Spontaneous common bile duct perforation: a rare clinical entity. Int J Surg Case Reports. 2018;46:34-7.

Mohanty SK, Mahapatra T. Spontaneous perforation of common bile duct in a young female: An intra-operative surprise. Int J Surgery Case Reports. 2017;35:17-20.

Torres GAG, Navarro RFM. Acute Abdomen Secondary to a Spontaneous Perforation of the Biliary Tract, a Rare Complication of Choledocholithiasis. Int J Surgery Case Reports. 2017;41:255-8.

Shawkya MAEG, Hassana AM. Spontaneous common bile duct perforation in an adult female patient presenting with severe epigastric pain mimicking acute pancreatitis, 2016 Al Azhar Assiut. Med J Published by Wolters Kluwer - Medknow.

Hamura R, Haruki K. Spontaneous biliary peritonitis with common bile duct stones: report of a case. Surg Case Reports. 2016;2:103.

Subasinghe D, Udayakumara EAD. Spontaneous Perforation of Common Bile Duct: A Rare Presentation of Gall Stones Disease, Hindawi Publishing Corporation Case Reports in Gastrointestinal Medicine Volume 2016, Article ID 5321304, 3 pages.

Kang SB, Han HS. Non-traumatic Perforation of the Bile Duct in Adults. Arch Surg. 2004;139.