A Case of Perforation of the Gallbladder Complicated by Congenital Biliary Dilatation

  • Nakayama Kei
    Department of Regenerative Surgery, Fukushima Medical University School of Medicine
  • Ise Kazuya
    Department of Regenerative Surgery, Fukushima Medical University School of Medicine
  • Shimizu Hirofumi
    Department of Regenerative Surgery, Fukushima Medical University School of Medicine
  • Yamashita Michitoshi
    Department of Regenerative Surgery, Fukushima Medical University School of Medicine
  • Ishii Shou
    Department of Regenerative Surgery, Fukushima Medical University School of Medicine
  • Hojo Hiroshi
    Department of Diagnostic Pathology, Fukushima Medical University School of Medicine
  • Gotoh Mitsukazu
    Department of Regenerative Surgery, Fukushima Medical University School of Medicine

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Other Title
  • 胆囊穿通をきたした先天性胆道拡張症の1例
  • 症例報告 胆囊穿通をきたした先天性胆道拡張症の1例
  • ショウレイ ホウコク タンノウセンツウ オ キタシタ センテンセイタンドウ カクチョウショウ ノ 1レイ

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Abstract

Congenital biliary dilatation can be found after biliary peritonitis owing to the perforation of the bile duct. The sites of perforation are mainly the common bile duct; the rupture of the gallbladder itself is very rare. We describe the case of a patient treated for gallbladder perforation (penetrating the liver) complicated by congenital biliary dilatation. A girl aged 1 year and 8 months presented with fever, vomiting, and abdominal distension. An abdominal ultrasonography and computed tomography showed thickening of the gallbladder wall and ascites. A laparoscopic abdominal exploration was performed with the probable diagnosis of acute cholecystitis. At the time of exploration, bile-stained fluid was found with perforation in the neck of the gallbladder. An intraoperative cholangiography revealed fusiform dilatation of the common bile duct, pancreaticobiliary maljunction, and protein plugs in the common channel. Cholecystectomy and abdominal cavity drainage were carried out, and radical surgery for congenital biliary dilatation was performed 3 months after the initial operation. In this case, a possible mechanism of gallbladder perforation would be an abrupt and abnormal increase in the intraluminal pressure of the gallbladder as well as of the bile duct induced by protein plugs in the common channel.

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