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CASE REPORT
Year : 2019  |  Volume : 6  |  Issue : 3  |  Page : 152-154

Spontaneous perforation of cystic duct in a 3-month-old Nigerian boy: a case report


1 Department of Paediatrics, Faculty of Clinical Sciences, College of Medical Sciences Department of Surgery, Ahmadu Bello University/Teaching Hospital, Shika, Zaria, Nigeria
2 Division of Paediatrics Surgery, Department of surgery, Faculty of Clinical Sciences, College of Medical Sciences, Ahmadu Bello University/Teaching Hospital, Shika, Zaria, Nigeria

Correspondence Address:
Dr. Musa S
Department of Paediatrics, Faculty of Clinical Sciences, College of Medical Sciences, Ahmadu Bello University/Teaching Hospital, Shika, Zaria
Nigeria
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DOI: 10.4103/ssajm.ssajm_7_19

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Introduction: Biliary ascites is a rare condition in infancy and is commonly caused by the perforation of the extrahepatic bile duct. The cystic duct is the part of extrahepatic biliary tract most rarely affected. This is likely to be the first case of biliary ascites of infancy, secondary to spontaneous cystic duct perforation in our centre. Methods: Consent was obtained from the parents of the child. Ethical approval was also obtained from the research and ethics committee of Ahmadu Bello University Teaching Hospital, Shika, Zaria. The case notes of the child were summarized and the relevant literature was reviewed to give the report a context. Results: A three-month-old boy presented with ten days history of jaundice, a week history of abdominal distention, and a day’s history of fever. There was associated bilateral inguinal hernia, excessive cry, refusal to feed, and weight loss. Pregnancy history was normal. He was acutely ill-looking, irritable, febrile with an axillary temperature of 37.7°C, mildly pale, jaundiced with a greenish tinge, had a weight of 4.7kg. He had gross ascites and bilateral reducible inguinal hernia. Bedside abdominal paracentesis reveals thick yellow and foamy fluid. Abdominal ultrasound scan revealed gross ascites, clotting profile was deranged, there was hyperbilirubinaemia of 228 umol/L, other laboratory results including liver function test were normal. He was commenced on medical management for presumed sepsis with obstructive jaundice. Five days into the admission, there was no significant improvement, and the diagnosis was reviewed to a ruptured choledochal cyst and the child was prepared for an explorative laparotomy. Intra-operatively, the cystic duct was perforated. Cholecystectomy and repair of the common bile duct were performed and the child did well postoperatively. Conclusion: Perforated cystic duct should be suspected in infants presenting with jaundice abdominal distension, acholic stools with or without fever, vomiting, and inguinal hernias. Early diagnosis and prompt surgical intervention greatly reduce morbidity and mortality from the disease.


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