Spontaneous bile duct perforation in a neonate

We present a case of spontaneous biliary perforation (SBP) in a previously healthy 3-week-old boy with worsening scleral icterus, abdominal distension, and acholic stools. Abdominal ultrasound demonstrated moderate ascites without extrahepatic ductal dilatation. The HIDA scan demonstrated accumulation of tracer within the right upper quadrant outside of the liver but not in the bowel, however there was a large amount of tracer activity seen diffusely within the abdomen that appeared to lie within the ascitic fluid and complicated the read of the scan. Intraoperative cholangiogram during an exploratory laparotomy confirmed an intact gallbladder with a mostly contained perforation at the junction of the cystic duct and the common bile duct with no contrast in the duodenum. The patient underwent an uneventful cholecystectomy with a Roux-en-Y hepaticojejunostomy and was discharged home three days later.