Perforation of the biliary tree mostly results from injury to the bile duct during surgery or procedures such as endoscopic retrograde cholangiopancreatography (ERCP) and spontaneous bile duct perforation is rare in adults. As the clinical picture varies, early diagnosis and treatment of spontaneous biliary peritonitis is difficult. A 52-year-old male patient presented with abdominal pain and intractable ascites. He already experienced severe abdominal pain 2 months ago and underwent percutaneous pigtail drainage for the ascites at nearby hospital. ERCP showed large filling defect with leakage of contrast media from the mid common bile duct (CBD) into the peritoneal cavity. We performed endoscopic sphincterotomy and extracted CBD stones with basket and balloon catheter. Then fully covered self expandable metal stent was placed in CBD. After the procedure, the symptom was improved and the amount of pigtail drainage from abdominal cavity was dramatically decreased. 6 weeks later, removing the metal stent, there was no more leakage of contrast media into peritoneal cavity. We report a very rare case of spontaneous bile leakage which was successfully managed with placement of metal stent.
Abdominal Cavity ; Abdominal Pain ; Adult ; Ascites ; Bile ; Bile Ducts ; Biliary Tract ; Catheters ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct* ; Contrast Media ; Drainage ; Early Diagnosis ; Humans ; Male ; Middle Aged ; Peritoneal Cavity ; Peritonitis ; Self Expandable Metallic Stents ; Sphincterotomy, Endoscopic ; Stents*

Perforation of the biliary tree mostly results from injury to the bile duct during surgery or procedures such as endoscopic retrograde cholangiopancreatography (ERCP) and spontaneous bile duct perforation is rare in adults. As the clinical picture varies, early diagnosis and treatment of spontaneous biliary peritonitis is difficult. A 52-year-old male patient presented with abdominal pain and intractable ascites. He already experienced severe abdominal pain 2 months ago and underwent percutaneous pigtail drainage for the ascites at nearby hospital. ERCP showed large filling defect with leakage of contrast media from the mid common bile duct (CBD) into the peritoneal cavity. We performed endoscopic sphincterotomy and extracted CBD stones with basket and balloon catheter. Then fully covered self expandable metal stent was placed in CBD. After the procedure, the symptom was improved and the amount of pigtail drainage from abdominal cavity was dramatically decreased. 6 weeks later, removing the metal stent, there was no more leakage of contrast media into peritoneal cavity. We report a very rare case of spontaneous bile leakage which was successfully managed with placement of metal stent.
Abdominal Cavity ; Abdominal Pain ; Adult ; Ascites ; Bile ; Bile Ducts ; Biliary Tract ; Catheters ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct* ; Contrast Media ; Drainage ; Early Diagnosis ; Humans ; Male ; Middle Aged ; Peritoneal Cavity ; Peritonitis ; Self Expandable Metallic Stents ; Sphincterotomy, Endoscopic ; Stents*