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Cardiology2 papers

Perforation of biliary tree

Last edited: 4/23/2026

Overview

Spontaneous biliary perforation (SBP) is a rare neonatal condition characterized by a defect in the bile duct, typically at the junction of the cystic duct and common hepatic duct, leading to bile leakage into the peritoneal cavity 1.

Diagnosis

  • Clinical Presentation: Jaundice, abdominal distension, and signs of peritonitis 1.
  • Imaging: Abdominal ultrasound and CT scan to identify bile leakage and anatomical details 1.
  • Laboratory Tests: Elevated liver enzymes (ALT, AST), bilirubin levels, and white blood cell count 1.

    • Management

  • Surgical Intervention: Hepaticojejunostomy-en-Roux for definitive repair 1.
  • Supportive Care: Fluid resuscitation, antibiotics to prevent infection, and management of complications like portal vein thrombosis 1.

    • Special Populations

  • Pediatrics: Posterior perforations may occur, leading to delayed diagnosis and increased risk of portal vein thrombosis and chylous ascites 1.

    • Key Recommendations

  • Prompt surgical intervention with hepaticojejunostomy-en-Roux is crucial for managing spontaneous biliary perforation in neonates (Evidence: Strong 1).
  • Monitor for and manage potential complications such as portal vein thrombosis and chylous ascites, especially in cases with posterior perforations (Evidence: Moderate 1).
  • Early imaging with CT and ultrasound aids in accurate diagnosis and planning of surgical repair (Evidence: Moderate 1).

    • References

    1 Livesey E, Davenport M. Spontaneous perforation of the biliary tract and portal vein thrombosis in infancy. Pediatric surgery international 2008. link

    Original source

    1. [1]
      Spontaneous perforation of the biliary tract and portal vein thrombosis in infancy. — Livesey E, Davenport M Pediatric surgery international (2008)
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