Russian Journal of Pediatric Surgery, Anesthesia and Intensive CareRussian Journal of Pediatric Surgery, Anesthesia and Intensive CareРоссийский вестник детской хирургии, анестезиологии и реаниматологии2219-40612587-6554Eco-Vector128510.17816/psaic1285Case reportsКлинические случаиResearch ArticleSpontaneous biliary perforation in a child: case report and reviewСпонтанная билиарная перфорация у ребенка: клиническое наблюдение и обзор литературыhttps://orcid.org/0000-0002-6684-54236893-6854PavlushinPavel M.ПавлушинПавел Михайлович
Russian Federation

Postgraduate Student, Pediatric Surgeon

аспирант кафедры госпитальной и детской хирургии, детский хирург

pavlushinpav@mail.ruhttps://orcid.org/0000-0002-6969-68657291-7988PorshennikovIvan A.ПоршенниковИван Анатольевич
Russian Federation

Cand. Sci. (Med.), Head of the Surgical Department for organ transplantation

канд. мед. наук, заведующий хирургическим отделением по пересадке органов

dxo-26@yandex.ruhttps://orcid.org/0000-0003-4418-71059573-2510PavlikVladimir N.ПавликВладимир Николаевич
Russian Federation

Pediatric Surgeon

врач-хирург

dxo-26@yandex.ruhttps://orcid.org/0000-0003-1176-67417536-5976TsyganokVladislav N.ЦыганокВладислав Николаевич
Russian Federation

Pediatric Surgeon

врач – детский хирург

dxo-26@yandex.ruhttps://orcid.org/0000-0001-7338-72759818-3830GramzinAlexey V.ГрамзинАлексей Владимирович
Russian Federation

Cand. Sci. (Med.), Head of the Pediatric Surgical Department

канд. мед. наук, заведующий детским хирургическим отделением

dxo-26@yandex.ruNovosibirsk State Medical UniversityНовосибирский государственный медицинский университетNovosibirsk District Clinical HospitalНовосибирская областная клиническая больница20122022190120231245055121209202213122022Copyright ©; 2023, Eco-VectorCopyright ©; 2023, Эко-Вектор2023Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0https://rps-journal.ru/jour/article/view/1285

Spontaneous perforation of the external biliary tract is an extremely rare pathology in childhood, presented in the literature by description of clinical cases. To date, a unified approach to the treatment of children with this pathology has not been developed.

The paper presents a clinical case of spontaneous perforation of the anterior wall of the common hepatic duct in a child of seven months, with the development of bilioperitoneum against the background of obstruction of the common bile duct by bilirubin calculi.

CASE REPORT. The disease began acutely with repeated vomiting, stool acholia, dark urine, and an increase in the size of the abdomen in a 7-month-old child. Examination in the hospital revealed ascites, cholecystitis and shadows of calculi in the projection of the hepatoduodenal ligament. According to the results of laparocentesis, bilioperitoneum was noted. The patient underwent laparotomy, 300 ml of serous-biliary effusion was removed from the abdominal cavity. On the anterior semicircle of the common hepatic duct there is a defect from which bile flows. Suturing of the perforation of the biliary tree, cholecystectomy and drainage of the external bile ducts through the stump of the cystic duct were performed. The cholangiostomy was removed after 1.5 months. Follow-up 1 year and 3 months, pathology is not determined during the examination.

CONCLUSIONS. Sewing up the site of primary perforation with drainage of the external biliary tract can help accelerate the reparative process with a decrease in the risk of developing a biliary fistula. Performing primary reconstructive interventions on the abdominal cavity compromised by bilioperitoneum, in our opinion, is too risky.

Спонтанная перфорация наружных желчных путей — крайне редкая патология в детском возрасте, представленная в литературе описанием клинических случаев. До настоящего времени не разработан единый подход к лечению детей с данной патологией. В работе представлен клинический случай спонтанной перфорации передней стенки общего печеночного протока у ребенка семи месяцев, с развитием билиоперитонеума на фоне обструкции билирубиновыми конкрементами общего желчного протока.

Описание клинического наблюдения. У ребенка семи месяцев заболевание началось остро с многократной рвоты, ахолии стула, темной мочи и увеличения размеров живота. При обследовании в стационаре выявлен асцит, холецистит и тени конкрементов в проекции гепатодуоденальной связки. По результатам лапароцентеза констатирован билиоперитонеум. Пациенту была выполнена лапаротомия, из брюшной полости удалено 300 мл серозно-желчного выпота. На передней полуокружности общего печеночного протока имеется дефект, из которого поступает желчь. Проведено ушивание перфорации билиарного дерева, холецистэктомия и дренирование наружных желчных путей через культю пузырного протока. Холангиостома удалена через 1,5 мес. Катамнез 1 г. 3 мес., при обследовании патологии не определяется.

Заключение. Ушивание места первичной перфорации с дренированием наружных желчных путей может способствовать ускорению репаративного процесса с уменьшением рисков развития билиарной фистулы. Первичные реконструктивные вмешательства на скомпрометированной билиоперитонеумом брюшной полости, по нашему мнению, являются излишне рискованным.

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