Spontaneous biliary perforation in an infant: A case report

Spontaneous biliary perforation (SBP) is a rare and potentially life-threatening condition in infants, often presenting with acute abdomen and jaundice. A 6-month-old baby girl presented to us with sudden onset abdominal distension, non-bilious vomiting, and non-passage of stools. Physical examination revealed no clinically evident jaundice, distended abdomen and tenderness. Laboratory investigations showed leukocytosis and elevated bilirubin. Ultrasound study showed mild ascites with bowel edema. We performed an exploratory laparotomy and found biliary peritonitis caused by perforations at the gallbladder neck and common bile duct distal to the cystic duct, without any biliary dilatation. The patient underwent cholecystectomy and hepaticoduodenostomy. Postoperative recovery was uneventful, with normalization of liver function and no recurrence during a twelve month follow-up period. SBP is a rare event but should be suspected in children who develop acute abdominal distension and jaundice.