Spontaneous biliary perforation in a 7-year-old child

Spontaneous biliary perforation is a rare cause of surgical jaundice in infants and children. It typically presents in infants aged 1–12 weeks. Fewer than 200 cases have been reported in the medical literature. The lack of knowledge regarding the pathogenesis of spontaneous biliary perforation and its extreme rarity makes preoperative diagnosis and its management difficult. We report a case of a 7-year-old boy with spontaneous biliary perforation, who presented with clinical features of acute peritonitis. Cholecystectomy with simple drainage by using a T-tube resulted in satisfactory recovery. We suggest that in a jaundiced child with symptoms of abdominal pain, distension, vomiting, acholic stools, and a previous anicteric period of good health, the diagnosis of spontaneous biliary perforation should be considered if there is a triad of: (1) signs of peritonitis; (2) absence of pneumoperitoneum on erect abdominal radiography; and (3) bilious abdominal paracentesis under ultrasonographic guidance. Routine abdominal paracentesis is not recommended for infants and children. Although there are several surgical options for the disease, cholecystectomy, flushing of the bile duct and external biliary drainage, constitute the most favorable treatment. Pediatricians and surgeons should consider this disease because early surgical intervention is the only option for ensuring a favorable prognosis.