背景:在许多急腹症的病因中,自发性胆总管穿孔(SCBDP)导致胆汁性腹膜炎几乎从未设想过。由于术语SCBDP经常被误解为缺乏可识别的穿孔原因,“CBD的非创伤性穿孔”也可以排除相对常见的原因,例如创伤和医源性损伤。在成年人中,胆总管囊肿,胆管炎,感染,胰腺炎,胰胆管连接不良已被确定为穿孔的原因,然而,胆总管结石仍然是与肝外胆管自发性穿孔相关的最常见原因。
方法:这里我们介绍3例自发性胆总管穿孔,表现为急腹症伴腹膜炎。临床表现,生化异常,成像细节,治疗方案,和结果进行了研究。据报道,这项研究符合SCARE2020指南[1]。
结论:肝外胆管自发性穿孔是成人胆结石的罕见但重要表现,在日常实践中需要高度怀疑。外科医生应在患者中寻找这种罕见的诊断,以进行早期手术干预和适当的引流,以确保生存。
BACKGROUND: Among a plethora of causes of acute abdomen, spontaneous common bile duct perforation (SCBDP) resulting in biliary peritonitis is almost never envisaged. Since the term SCBDP is often misconstrued as absence of an identifiable cause of perforation, \'nontraumatic perforation of CBD\' is also in parlance to exclude relatively common causes such as trauma and iatrogenic injuries. In adults, choledochal cyst, cholangitis, infection, pancreatitis, pancreatobiliary maljunction have been identified as causes of perforation, however, choledocholithiasis remains the most common cause associated with spontaneous perforation of extra hepatic bile duct.
METHODS: Here we present three cases of a spontaneous common bile duct perforation that presented as acute abdomen with peritonitis. Clinical presentation, biochemical abnormalities, imaging details, treatment options, and outcome were studied. This study has been reported in line with the SCARE 2020 Guideline [1].
CONCLUSIONS: Spontaneous perforation of the extrahepatic bile duct is a rare but important presentation of gallstones in adults and needs a high index of suspicion during day-to-day practice. Surgeons should seek out this uncommon diagnosis in the patient for early surgical intervention and appropriate drainage to ensure survival.