Rupture of the Common Bile Duct; A Rare Cause of Biliary Peritonitis

A 17-year-old unmarried female complained some pain in the right iliac fossa with associated nausea, vomiting and anorexia. Her examination revealed a conscious and febrile(38°C) patient with tenderness in right half. The laboratory findings showed leukocytosis at the time of admission. The patient was admitted to the surgical ward with provisional diagnosis of acute appendicitis. Laparoscopic appendicectomy was planned for the patient on the same day. When we introduced the camera, a sufficient amount of bile was noted in the peritoneal cavity. All other organs including appendix were examined and were found to be normal. Consequently, a diagnosis of perforation in the hepatobiliary system was made and the procedure was converted to open through a mid line laparotomy incision. Gall bladder was collapsed and there was 0.5 cm irregular perforation in the common bile duct. Per operative cholangiogram was unremarkable. A T tube was inserted and peritoneal cavity was washed with normal saline. A drain was placed down to the common bile duct and abdomen closed. The patient made uneventful recovery and was discharged home in a stable condition. Spontaneous Common Bile Duct Injury is extremely rare which should be considered by all physicians dealing with the patients with acute abdomen.