PERFORATION OF THE COMMON BILE DUCT -AN ADULT CASE REPORT-

Perforation of the common bile duct can be associated with congenital biliary dilatation in childhood, but it rarely appears in adults. We experienced a case of perforation of the common bile duct with choledocholith in a 68-year-old man. The patient complaining of fever and upper abdominal pain was emergently admitted because upper abdominal CT and ultrasonography revealed calculus of the common bile duct and fluid collection of Morison's pouch. A remission of abdominal symptom was attained by conservative therapy, but an increase in white blood cell count and fever were sustained. The patient was underwent an emergency operation with a diagnosis of choledocholithis and intraabdominal abscess. Upon laparotomy, dense adhesion due to previous gastrectomy and cholecystectomy was present. The abscess cavity was filled with infectious bile and a perforation 3 mm in diameter in the anterior wall of the common bile duct under the confluence was found. Intraoperative cholangioscopy revealed a stone 15 mm in diameter under the site of perforation. The stone was taken out and a T-tube was placed in the hole. He had an uneventful postoperative course and was discharged from the hospital. We think that stone impaction might cause the perforation in this patient.