Spontaneous perforation of the common bile duct with eosinophilia in an 18-month-oldgirl: A case report and review of literature.
Mohammad Hadi Imanieh, Ashkan Mowla, Daryoush Zohouri, Hamid Reza Forootan, Mehran Karimi
Med Sci Monit 2006; 12(4): CS31-33
Background: Spontaneous perforation of the common bile duct is a rare butimportant cause of jaundice in infancy, requiring prompt diagnosis and surgical intervention. First describedin 1932, fewer than 150 cases have been reported to date. Case Report: The report concerns a 18-month-oldgirl who developed mild jaundice, abdominal distension, and constipation three days prior to admission.On admission, ascites and hepatomegaly were detected and the complete blood count was normal, but onthe 3[sup]rd[/sup], 4[sup]th[/sup], and 5[sup]th[/sup] days of admission, the blood cell count revealed elevation of the eosinophilcount to 16% of total WBC. Abdominal sonography showed a moderate amount of ascitic fluid and paracentesisdemonstrated biliary ascites. Hepatobiliary scintigraphy suggested leakage of bile to the abdominal cavity.Exploratory laparotomy revealed clear bilious ascitic fluid and a ruptured common bile duct at the anteriorwall of the junction of the cystic duct and the common bile duct. Three days after T-tube insertion andclosure of the perforation, the eosinophil count returned normal. Conclusions: Perforation of the bileduct may be considered as one of the differential diagnoses of eosinophilia. This point makes our casea unique study, worthy of being reported.
Keywords: Diagnosis, Differential, Common Bile Duct Diseases - surgery, Eosinophilia - etiology, Female, Humans, Jaundice - etiology, Rupture, Spontaneous