Spontaneous gangrene and perforation of choledochal cyst: a rare presentation

Authors

  • Atish Bansod Department of General Surgery, Indira Gandhi Govt. Medical College, Nagpur
  • Sunil Lanjewar Department of General Surgery, Indira Gandhi Govt. Medical College, Nagpur
  • Mahendra Kamble Department of General Surgery, Indira Gandhi Govt. Medical College, Nagpur
  • Kamalkant Singh Department of General Surgery, Indira Gandhi Govt. Medical College, Nagpur
  • Vaibhav Nasare Department of General Surgery, Indira Gandhi Govt. Medical College, Nagpur
  • Vivek Ghate Department of General Surgery, Indira Gandhi Govt. Medical College, Nagpur

DOI:

https://doi.org/10.18203/2349-2902.isj20151110

Keywords:

Choledochal cyst, Perforation, T-tube cholangiogram, Gangrene

Abstract

Choledochal cyst is a rare entity. It generally presents in children with pain, jaundice and the occasional finding of a lump in right hypochondriac region. A very rare presentation is biliary peritonitis resulting from a perforated choledochal cyst. It is usually seen in younger children. Our patient was a 14 year old female who presented with an acute abdomen. Clinically she had signs of peritonitis. Chest radiograph did not show free gas under diaphragm. The USG showed a dilated CBD of 4.1cm with a calculus at its lower end of 2 x 2.6cm, USG guided diagnostic tap revealed bile. Emergency exploration was done, a gangrenous patch of size 3 * 2cm in the anteromedial wall of large choledochal cyst was found with a perforation in it. No calculous was found. The gangrenous wall of choledochal cyst was excised and primary suturing of choledochal cyst was done with a T-tube placed through separate incision in choledochal cyst. As there is no facility for intra-operative cholangiogram in the emergency setting in our institute, a post-operative cholangiogram was done on day 7. It revealed a dilated CBD, CHD as well as right and left hepatic ducts (choledochal cyst type IA). The patient was discharged and asked to follow-up electively for excision of choledochal cyst at a later date. A rare possibility of a perforated choledochal cyst should be kept in mind in cases of biliary peritonitis, especially in younger age groups. Bile drainage would be a safer procedure in emergency condition, especially when patient presented late to hospital with hemodynamic unstability and edematous wall.

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http://emedicine.medscape.com/article/172099-overview.

http://medind.nic.in/jan/t03/i2/jant03i2p116o.pdf.

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Published

2016-12-14