Spontaneous perforation of a choledochal cyst after prolonged gastroenteritis

Ruptured choledochal cysts are a rare cause of biliary peritonitis. We report a case of a 21-month-old African American male found to have spontaneous rupture of a previously undiagnosed type I choledochal cyst in the setting of prolonged gastroenteritis symptoms. Though such perforations have traditionally been managed with drainage and delayed reconstruction, the inflammation and scarring associated with severe bile peritonitis may not improve significantly with time. As a single-stage primary reconstruction may not be feasible in the setting of prolonged illness, we present the successful use of a staged approach to primary reconstruction in accordance with 'damage control' principles.