Spontaneous perforation of the extrahepatic bile duct leading to biliary peritonitis is a rare occurrence once other causes of biliary peritonitis, such as trauma, choledochal cyst, stone diseases, and distal atresia of the bile duct, are ruled out. A 7-month-old male infant was brought to the hospital in critical condition with distension of the abdomen. He had a history of vomiting and diarrhoea, low-grade fever, and refusal to feed for 2 days. Signs of peritonitis were found upon examination. Due to the poor general condition of the patient, the case was taken up for laparotomy, and a diagnosis of spontaneous extrahepatic bile duct perforation was made intra-operatively. In the present case, the cause was idiopathic. An external drain was placed near the site of the leak for 2 weeks. The patient recovered well and was discharged on post-operative day 16. Disease awareness for correct pre-operative diagnosis and interventional planning is required to reduce mortality, morbidity, and complications in spontaneous perforation of the common bile duct.

We report a case of chronic myeloid leukemia (CML) that developed after postoperative chemotherapy with cyclophosphamide, doxorubicin and 5-fluorouracil (CAF) for breast cancer. A 55-year-old woman was diagnosed with invasive ductal carcinoma which was treated with a modified radical mastectomy followed by six cycles of CAF chemotherapy. Nine years later, she developed CML and locoregional recurrence. Her breast recurrence showed strong estrogen receptor, weak progesterone receptor and strong human epidermal growth factor 2 (score 3+) expression. Her secondary CML in the chronic phase showed a complex variant translocation (CVT) involving chromosomes 9, 22, and 17. Considering that the HER2/neu gene is also located on chromosome 17, this secondary CML in chronic phase with CVT is indeed a rare occurrence. We discuss the associated genetic factors and the possible role of breast cancer chemo/radiotherapy in the development of such CML as well as its treatment and prognosis compared with de novo CML.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Chromosomes, Human, Pair 17 ; Cyclophosphamide ; Doxorubicin ; Drug Therapy ; Epidermal Growth Factor ; Estrogens ; Female ; Fluorouracil ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Mastectomy, Modified Radical ; Middle Aged ; Prognosis ; Receptors, Progesterone ; Recurrence