Abstract
The patient is a 64-year-old man. He was admitted to the hospital with a complaint of abdominal pain and vomiting, due to intrahepatic bile duct dilation on CT scan. After admission, ERCP revealed a common bile duct stone, and during EST, bleeding was observed from the duodenal papilla. CT revealed air in the retroperitoneal space, and a diagnosis of retroperitoneal perforation. Conservative treatment with antibiotics was started. An attempt was made to decompress the bile duct using ENBD, but was abandoned due to difficulty in cannulation. During the treatment, biliary stasis due to papillary edema was suspected, and surgery was performed to decompress the bile duct. The surgical findings showed biliary ascites in Morrison’s fossa and a sub-serosal hemorrhage in the hepatoduodenal mesentery. Laparoscopic cholecystectomy was performed, and a C-tube was placed in the bile duct from the cystic duct. Cholangiography showed no obvious leakage of contrast medium outside the bile duct. Postoperative bile excretion from the C-tube was good, and cholangiography showed no problem. The C-tube was clamped on the 6 th postoperative day. The patient was discharged on postoperative day 14. We report a case of retroperitoneal perforation treated by laparoscopic surgery.
