Spontaneous Common Hepatic Duct Perforation: A Rare Cause of Acute Abdomen

DOĞU D., DİNÇER H. A.

Indian Journal of Surgery, 2026 (SCI-Expanded, Scopus)

  • Publication Type: Article / Article
  • Publication Date: 2026
  • Doi Number: 10.1007/s12262-026-04625-8
  • Journal Name: Indian Journal of Surgery
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, Academic Search Ultimate (EBSCO), Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest), Pharma Collection (ProQuest)
  • Keywords: Acute abdomen, Biliary peritonitis, Common hepatic duct perforation, Spontaneous bile duct rupture
  • Hacettepe University Affiliated: Yes

Abstract

Spontaneous perforation of the extrahepatic biliary tract is an extremely rare and life-threatening condition, particularly in adults. It often presents as acute abdomen and may mimic other hepatobiliary or gastrointestinal emergencies. A 73-year-old woman with multiple comorbidities, including congestive heart failure, chronic kidney disease with solitary kidney, chronic obstructive pulmonary disease, and kyphoscoliosis, was admitted for treatment of pneumonia. She presented with acute abdominal pain and was subsequently diagnosed with acute pancreatitis and biliary peritonitis. Imaging revealed a contracted gallbladder with stones and perihepatic fluid collection. Percutaneous drainage yielded 1300 mL of bilious fluid. Exploratory laparotomy revealed a perforation on the common hepatic duct. Cholecystectomy and T-tube drainage were performed. Despite intensive care, the patient developed septic shock and multiorgan failure, resulting in death on postoperative day 3. Adult spontaneous perforation of the common hepatic duct is exceptionally rare. The underlying mechanisms are thought to include increased intraductal pressure from gallstones, ischemia, or chronic inflammation. Diagnosis is often delayed due to nonspecific clinical presentation. Surgical intervention with drainage remains the mainstay of treatment, though mortality is high in elderly patients with comorbidities.