PDF(Pubmed)
Abstract：
Spontaneous perforation of the common bile duct (SPCBD) is an exceptional disease, especially in adults. The cause is often idiopathic once trauma and choledochal cyst are excluded. Early diagnosis is often difficult because of its often-misleading appearance.
UNASSIGNED: The authors report the case of a 54-year-old man, a known case of type 2 diabetes mellitus, who presented to our emergency department for acute abdominal pain that had evolved for 2 days.
UNASSIGNED: On physical examination, the patient had a fever of up to 38.5°C, and the abdomen was distended and generally tight. The abdominal computerized tomography scan confirms the presence of free fluid. In addition, the thickness of the gallbladder wall had increased in contrast with a resolved gallbladder distention. Because exploration failed to demonstrate the cause of ascites, the authors performed a diagnostic paracentesis, which revealing ascites with a dark yellow-green color, which implied bile leakage.After initial resuscitation, an emergent exploratory laparotomy was performed. The authors found biliary peritonitis secondary to SPCBD. After peritoneal lavage, the perforation was repaired over a T-tube. The postoperative course was uneventful. Histological findings were consistent with ulcerous acalculous cholecystitis. The patient was disease-free after a 3-month follow-up.
UNASSIGNED: SPCBD is an uncommon condition in adults, and it is rarely reported in the literature. The pathogenesis of this disease is not clear and may be related to single or multiple factors. Usually, this disease is diagnosed in the postmortem. Early diagnosis and optimal surgical treatment are challenging.
UNASSIGNED: This present case highlighted the preoperative diagnostic difficulties of the SPCBD. Emergent surgical management should be instituted in the shortest time possible to reduce the high mortality.
UNASSIGNED: The authors report the case of a 54-year-old man, a known case of type 2 diabetes mellitus, who presented to our emergency department for acute abdominal pain that had evolved for 2 days.
UNASSIGNED: On physical examination, the patient had a fever of up to 38.5°C, and the abdomen was distended and generally tight. The abdominal computerized tomography scan confirms the presence of free fluid. In addition, the thickness of the gallbladder wall had increased in contrast with a resolved gallbladder distention. Because exploration failed to demonstrate the cause of ascites, the authors performed a diagnostic paracentesis, which revealing ascites with a dark yellow-green color, which implied bile leakage.After initial resuscitation, an emergent exploratory laparotomy was performed. The authors found biliary peritonitis secondary to SPCBD. After peritoneal lavage, the perforation was repaired over a T-tube. The postoperative course was uneventful. Histological findings were consistent with ulcerous acalculous cholecystitis. The patient was disease-free after a 3-month follow-up.
UNASSIGNED: SPCBD is an uncommon condition in adults, and it is rarely reported in the literature. The pathogenesis of this disease is not clear and may be related to single or multiple factors. Usually, this disease is diagnosed in the postmortem. Early diagnosis and optimal surgical treatment are challenging.
UNASSIGNED: This present case highlighted the preoperative diagnostic difficulties of the SPCBD. Emergent surgical management should be instituted in the shortest time possible to reduce the high mortality.
摘要：
胆总管自发性穿孔（SPCBD）是一种特殊的疾病，尤其是成年人。一旦排除创伤和胆总管囊肿，原因通常是特发性的。早期诊断往往是困难的，因为它经常误导的外观。
未经授权：作者报告了一名54岁男子的病例，一个已知的2型糖尿病病例,他因急性腹痛出现在我们的急诊科，这种疼痛已经持续了2天。
未经授权：在体检时，病人发烧高达38.5摄氏度，腹部扩张，通常很紧。腹部计算机断层扫描证实存在游离液体。此外,与解决的胆囊扩张相比，胆囊壁的厚度增加了。因为探索未能证明腹水的原因，作者进行了诊断性穿刺，露出深黄绿色的腹水，这意味着胆漏。初步复苏后,进行了紧急剖腹探查术.作者发现继发于SPCBD的胆汁性腹膜炎。腹腔灌洗后,穿孔是在T形管上修复的。术后病程顺利。组织学发现与溃疡性非结石性胆囊炎一致。经过3个月的随访，患者无病。
未经评估：SPCBD在成人中并不常见，这在文献中很少报道。本病的发病机制尚不明确,可能与单因素或多因素有关。通常,这种疾病是在死后诊断出来的。早期诊断和最佳手术治疗具有挑战性。
UNASSIGNED：本病例强调了SPCBD的术前诊断困难。应在尽可能短的时间内进行紧急手术治疗，以降低高死亡率。
未经授权：作者报告了一名54岁男子的病例，一个已知的2型糖尿病病例,他因急性腹痛出现在我们的急诊科，这种疼痛已经持续了2天。
未经授权：在体检时，病人发烧高达38.5摄氏度，腹部扩张，通常很紧。腹部计算机断层扫描证实存在游离液体。此外,与解决的胆囊扩张相比，胆囊壁的厚度增加了。因为探索未能证明腹水的原因，作者进行了诊断性穿刺，露出深黄绿色的腹水，这意味着胆漏。初步复苏后,进行了紧急剖腹探查术.作者发现继发于SPCBD的胆汁性腹膜炎。腹腔灌洗后,穿孔是在T形管上修复的。术后病程顺利。组织学发现与溃疡性非结石性胆囊炎一致。经过3个月的随访，患者无病。
未经评估：SPCBD在成人中并不常见，这在文献中很少报道。本病的发病机制尚不明确,可能与单因素或多因素有关。通常,这种疾病是在死后诊断出来的。早期诊断和最佳手术治疗具有挑战性。
UNASSIGNED：本病例强调了SPCBD的术前诊断困难。应在尽可能短的时间内进行紧急手术治疗，以降低高死亡率。
