BACKGROUND: Spontaneous perforation of the common bile duct is a rare but important cause of jaundice in infancy, requiring prompt diagnosis and surgical intervention. First described in 1932, fewer than 150 cases have been reported to date. CASE REPORT: The report concerns a 18-month-old girl 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 on the 3rd, 4th, and 5th days of admission, the blood cell count revealed elevation of the eosinophil count to 16% of total WBC. Abdominal sonography showed a moderate amount of ascitic fluid and paracentesis demonstrated 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 anterior wall of the junction of the cystic duct and the common bile duct. Three days after T-tube insertion and closure of the perforation, the eosinophil count returned normal. CONCLUSIONS: Perforation of the bile duct may be considered as one of the differential diagnoses of eosinophilia. This point makes our case a unique study, worthy of being reported.
BACKGROUND: Spontaneous perforation of the common bile duct is a rare but important cause of jaundice in infancy, requiring prompt diagnosis and surgical intervention. First described in 1932, fewer than 150 cases have been reported to date. CASE REPORT: The report concerns a 18-month-old girl 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 on the 3rd, 4th, and 5th days of admission, the blood cell count revealed elevation of the eosinophil count to 16% of total WBC. Abdominal sonography showed a moderate amount of ascitic fluid and paracentesis demonstrated 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 anterior wall of the junction of the cystic duct and the common bile duct. Three days after T-tube insertion and closure of the perforation, the eosinophil count returned normal. CONCLUSIONS: Perforation of the bile duct may be considered as one of the differential diagnoses of eosinophilia. This point makes our case a unique study, worthy of being reported.