SPONTANEOUS PERFORATION OF THE BILE DUCT IN INFANTS: A CASE REPORT

Abstract Spontaneous perforation of the bile duct is a rare disease in children. To date, less than a hundred cases have been reported in English literature. A number of techniques have been applied to achieve preoperative diagnosis yet most cases are diagnosed at operation. A 3-month-old girl presented with fever, vomiting, progressive abdominal distension, jaundice and diarrhoea. Abdominal ultrasonography showed localized collection of fluid that displaced the small bowel to the right side of the abdomen. The fluid was found to be bilious on paracentesis. At laparotomy, biliary pseudocyst was found but the site of perforation was no longer identifiable. Excision of the containing wall and external drainage was carried out. 9 months after operation the child is well. A high index of suspicion should improve diagnosis and ensure early intervention. Mots cles: Canal biliaire, perforation spontanee, enfant Resume La perforation spontanee des canaux biliaires est une affection rare chez les enfants. A ce jour, moins de 100 cas ont ete rapportes dans la litterature anglophone. Un certain nombre de techniques ont ete mises en œuvre pour le diagnostic pre operatoire, neanmoins la plupart des cas sont de diagnostic per operatoire. Une fille de 3 mois avait presente de la fievre, vomissements, distension progressive de l’abdomen, ictere et diarrhee. L’echographie de l’abdomen avait montre une collection liquidienne localisee refoulant les anses greles vers le cote droit de l’abdomen. La paracentese avait retrouve un liquide bilieux. La laparotomie avait note un pseudo kyste biliaire, mais le siege de la perforation n’etait plus visible. La paroi du contenant a ete excisee et un drainage externe a ete realise. Neuf mois apres l’operation, les suites etaient simples. Une forte suspicion devrait mener au diagnostic et imposer une intervention precoce.