Spontaneous perforation of the common bile duct in children

The authors describe radiologic findings in five patients with spontaneous perforation of the common bile duct (a rare disorder). The patients were 5 weeks, 9 weeks, 3 months, 11 months, and 2 1/2 years old at presentation. The most common presenting complaints were jaundice and abdominal distention (due to ascites). Sonograhic findings included ascites in three patients, a loculated fluid collection around the gallbalder in two patients, and both in one patient. The biliary tree was undilated in all patients. Results of hepatobiliary scintigraphy definitely demonstrated that intraperitoneal fluid originated from the biliary tract. Intraoperative cholangiography was used to confirm the diagnosis at surgery. All children were successfully treated with surgery. Recognition of these findings on sonograms and subsequent confirmation with scintigraphy are important to prevent delays in diagnosis of a potentially fatal condition.