Spontaneous extrahepatic biliary tree perforation

Spontaneous perforation of the common bile duct is an extremely uncommon cause of an abdominal emergency. Owing to the rarity of the condition it is seldom suspected or diagnosed preoperatively. We report a case of a 42-year-old female presenting with features of severe biliary pancreatitis who responded well to organ support. Five days post admission she was deemed fit for cholecystectomy to prevent further attacks of pancreatitis. Surgery revealed a common hepatic duct perforation treated with cholecystectomy, lavage and common hepatic duct drainage. This was followed by postoperative biliary stenting which led to complete resolution without further surgery. This conservative staged approach obviated the need for major biliary reconstruction and is a viable strategy when confronted with this rare complication without prior ductal imaging.