Abstract
An 81-year-old man was admitted to our hospital because of abdominal pain. Abdominal CT showed calculus of the common bile duct and a fluid collection under the left diaphragm. On the same day, the patient underwent emergency surgery. The intraperitoneal space was filled with bile and ascites. The surface of the liver showed a pinhole and a bile fistula. Intrahepatic bile duct rupture was diagnosed, and partial hepatectomy, cholecystectomy, and choledocholithotomy were performed, with placement of a T-tube. The patient's postoperative course was favorable, resulting in discharge 25 days after surgery. Bile peritonitis due to spontaneous bile duct rupture is rare. Among such cases, intrahepatic bile duct rupture is even rarer and has almost never been reported. Though this disease is very rare, it should be included in the differential diagnosis of bile peritonitis.
