A Rare Cause of Acute Abdomen in Children: Spontaneous Rupture of Choledochal Cyst Causing Peritonitis

Spontaneous rupture of the common bile duct cyst is a rare cause of acute abdomen in children. In our case, we present a 3-year-old patient with no history of trauma, whose diagnosis was confirmed by laparotomy, with a possible suspected common bile duct cyst due to massive ascites and a cystic lesion in the portal area. Although common bile duct cysts are mostly asymptomatic, various studies have shown that malignant transformation can cause important complications such as pancreatitis.Numerous causes have been suggested in the etiopathogenesis of rupture, such as parietal necrosis associated with pancreatic reflux irritation.Since rupture of cysts may require urgent laparotomy such as biliary peritonitis, it is important to know imaging findings that may be warning for early diagnosis. Because of the increased risk of cholangiocarcinoma after cyst excision, cholecystectomy and Roux-en-Y hepaticojejunostomy are the most common treatment procedures.

The clinical analysis of endoscopic pancreaticobiliary separation in the treatment of occult pancreaticobiliary reflux

Objective To investigate the aetiology of occult pancreaticobiliary reflux (OPBR) and the curative effect of EST in patients with cholecystolithiasis. Methods The clinical data of 47 OPBR patients with cholecystolithiasis from October 2013 to October 2016 were analyzed retrospectively.Results The average gallbladder bile amylase (GBA) of 47 patients was 864 ± 575 U/L. Forty patients underwent endoscopic retrograde cholangiopancreatography (ERCP), among which 26 patients were diagnosed with papillitis, 16 patients with peripapillary diverticulum, 14 patients with nipple overlength, five patients with nipple atrophy, three patients with ampullary calculi and two patients with papillary tumour. Thirty-three patients underwent endoscopic sphincterotomy (EST), after the operation, 16 patients reexamined GBA, in which 15 patients had normal GBA, and the difference of GBA was statistically significant (1161 ± 764 U/L vs 47 ± 17 U/L, t=5.641, P<0.05). After following up of 1 to 4 years, 27 patients without cholecystectomy who underwent EST had no recurrence of calculus, and in 9 patients who did not undergo EST, two patients had a recurrence of calculus. There was a significant difference in the recurrence rate of calculus (χ2=21.340, P<0.05). Conclusion Pancreaticobiliary junction disease is an essential cause of OPBR and cholecystolithiasis formation. EST can reduce the retention of pancreatic reflux juice both in gallbladder and bile duct and can reduce the recurrence rate of cholecystolithiasis after choledochoscopic lithotomy.