Abstract
Purpose: Bile duct perforation (BDP) is a rare complication of choledochal cyst. We investigated the clinical features and management of choledochal cyst associated with BDP. Methods: One hundred and fifty-five patients with choledochal cyst were treated at our institution, and we reviewed clinical courses in seven patients with BDP (4.5%). Results: The age of them ranged from 1 to 5 years old, and they consisted of 2 males and 5 females. It took 3 to 13 days from onset to the first surgery. Five patients were diagnosed with choledochal cyst before the BDP. The shape of the extrahepatic bile duct was fusiform in 6 patients. The sites of perforation were in the anterior wall of the common bile duct in 5, and in the posterior wall in 2. In all cases, the initial surgical management was abdominal drainage and biliary drainage such as cholecystostomy or T-tube drainage; a biliary reconstruction was performed about one month after the first operation. Conclusions: Because infant cases with fusiform shape of the extrahepatic bile duct are one of the risk factors of BDP, we recommend careful observation with ultrasono-graphic study and blood examination in those cases. We consider that a primary biliary reconstruction is possible in selected patients with BDP, but biliary and abdominal drainage are safe initial treatment for BDP.
