Ruptured biliary cyst with biliary peritonitis – a case report

Abstract

Introduction: Biliary cysts account for approximately 1-3% of all benign biliary diseases and their spontaneous rupture is extremely rare. The authors present a case where the initial event was biliary peritonitis. Case report: 72-year-old woman, admitted to the surgery ward with acute pancreatitis, with 2 Ranson criteria. Following the initial favourable evolution, there was a worsening in her clinical status, biliary obstruction, multiple organ dysfunction and admission to the Intensive Care Unit. She developed an acute abdomen, which led to an urgent laparotomy, with the diagnosis of a biliary peritonitis. A biliary tract decompression and a per-operatory cholangiography were performed, with no identification of the origin of the leak. It was necessary to perform a laparostomy. At a 48h-reviewing laparostomy, another cholangiography was performed, showing a ruptured biliary cyst, with contrast leak in the IVb hepatic segment. Conclusion: This case reports the peculiar etiology of a ruptured biliary cyst, with the presentation of a biliary peritonitis in a patient admitted with acute pancreatitis.