Total laparoscopic management of spontaneous biliary perforation
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CASE REPORT
Total laparoscopic management of spontaneous biliary perforation Lawrence Jun Leung1 · Marc James Henry Vecchio2 · Ajay Rana3 · Allison Behrle‑Yardley3 · Nathalie Brewer3 · Whitney McBride3 Received: 23 October 2019 / Accepted: 31 March 2020 © Japanese Society of Gastroenterology 2020
Abstract Spontaneous biliary perforation (SBP) in pediatrics is rare and historically has been treated with laparotomy for attempted repair and cholecystectomy. In recent years, management has evolved into a conservative approach, opting for cholecystostomy and peritoneal drainage over cholecystectomy. In this case, we report the first successful conservative management of SBP using an exclusively laparoscopic approach without cholecystectomy in a pediatric patient. Keywords Spontaneous · Biliary · Perforation · Management
Introduction Spontaneous biliary perforations (SBP)—first described in 1932 by Dijkstra [1]—are rare with an incidence of 1.5 in 1,000,000 live births [2] and typically with a presentation in children under four years of age [3]. Although uncommon, SBP is an important precipitating cause of jaundice in the early years of life [4]. Both surgical [2, 5–7] and nonsurgical [3, 8–10] management of SBP have been utilized in the past to varying results. Surgical management of SBP historically consisted of open procedures via laparotomies for diagnosis, attempted repair—to no documented success—and subsequent cholecystectomy [2, 5, 11, 12]. Management has changed to a conservative surgical approach consisting of cholecystostomy and peritoneal tube drainage without attempt at repair or cholecystectomy [2, 13]. Additionally, minimally invasive laparoscopy [2, 13, 14] have been utilized to varying degrees in diagnostics and management, but have yet to be successful in therapeutic conservative management. This case describes
* Lawrence Jun Leung [email protected] 1
Kaiser Permanente San Francisco, 2425 Geary Blvd, San Francisco, CA 94115, USA
2
Rhode Island Hospital Brown University, 80 Dudley St, Providence, RI 02905, USA
3
Northern Light Eastern Maine Medical Center, 489 State St, Bangor, ME 04401, USA
the first successful total laparoscopic conservative management of SBP in a neonate.
Case presentation Informed consent was obtained from the patient’s mother for the details and images encompassing this case. A 3-week-old, 4.2 kg African American female presented to the emergency department (ED) with poor feeding and acholic stools. On examination vital signs were within normal limits, she appeared well nourished, and had no scleral icterus or jaundice. Her abdomen was soft with no crying on palpation and non-distended with normoactive bowel sounds. Initial laboratory studies were significant for elevated total bilirubin (2.0 mg/dL), direct bilirubin (1.3 mg/ dL), gamma-glutamyl transferase (GGT) (754 IU/L), alanine aminotransferase (ALT) (72 IU/L), and aspartate aminotransferase (AST) (45 IU/L). The patient was worked up for biliary atresia by abdominal ultrasound of the liver and gallbl
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