Bile peritonitis due to spontaneous perforation of the common hepatic duct. Report of a case.

A 55-year-old female, previously cholecystectomized, was admitted to hospital with signs of severe acute abdomen. At laparotomy, bile peritonitis was found, but the site of leakage could not be discovered. The biliary tree was otherwise normal and without stones. The treatment was confined to drainage of the common bile duct by inserting a T-tube. In spite of intensive postoperative care the patient died. Autopsy showed a perforation opening in the common hepatic duct on the posterior wall and a solitary stone was detected in the adjacent retroperitoneal tissue. The mechanism to this rare condition is discussed and a review of earlier similar cases is given. The benefit of routine cholegraphy in order to avoid retained stones is briefly mentioned.