Biliary Peritonitis Due to Bile Leakage Without Perforation, Associated With Infection of Diphyllobothrium nihonkaiense: A Report of a Pediatric Case

Abstract

The patient was a 14-year-old boy who liked to eat salmon sashimi, enjoying it daily. He had sudden onset right abdominal pain and visited the pediatric Emergency Care Center at our institution. Muscular defense and rebound pain were confirmed on the right side of the abdomen on physical examination. A blood examination revealed an elevated white blood cell count and the presence of hepatobiliary enzymes. Abdominal enhanced computed tomography showed a slightly high density of ascites around the gallbladder and right lower quadrant. No gallstone or biliary dilatation was recognized. Laparoscopic exploration revealed clear yellowish biliary ascites and yellow degeneration of the neck of the gallbladder serosa without perforation. We did not perform cholecystectomy but instead lavaged the abdominal cavity and inserted drains with tips placed inferior to the liver and Douglas pouch. After the operation, the patient’s systemic condition improved promptly, and his abdominal pain almost disappeared one day after the surgery. The contents of the drain also shifted to serous ascites. A microscopic examination of the feces revealed a large number of parasitic eggs diagnosed on the basis of their shape as Diphyllobothrium nihonkaiense. The patient took Praziquantel and excreted a tapeworm the next day. There was no relapse of abdominal symptoms, and the patient was discharged on the 14th postoperative day. Biliary peritonitis without perforation coexisting with tapeworm infection is extremely rare.