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Спонтанная перфорация в системе желчных протоков

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Цель. Оценка различных лечебно-диагностических подходов при спонтанной перфорации желчных протоков. Материал и методы. Сообщения о спонтанных перфорациях в системе желчных протоков, опубликованные с 01.01.2000 по 01.06.2022, были отобраны структурированным поиском в базе PubMed/Medline. Результаты. По результатам систематического поиска в исследование было включено 58 публикаций, содержащих сведения о 71 пациенте. Наиболее частые симптомы заболевания – боль в животе (92,9%), лихорадка (39,4%), желтуха (33%). Предварительный диагноз был правильно установлен 52,1% больных. Чаще всего развитие заболевания было связано с холедохолитиазом (38%). Перфорация желчных протоков левой доли печени выявлена в 40,6% наблюдений, перфорация общего желчного протока – в 35,5%. У 42,2% больных перфорация желчных протоков привела к развитию перитонита, у 30,9% – к формированию скопления желчи или абсцессу. Подкапсульное и внутрипеченочное скопление желчи обнаружено в 18,3% наблюдений. Лечение при перфорациях с развитием подкапсульного и внутрипеченочного скопления желчи осуществляли комбинированно, применяли чрескожное чреспеченочное дренирование и эндоскопические методы. Перфорация желчных протоков с развитием распространенных форм заболевания требовала двухэтапного лечения. На первом этапе выполняли санацию брюшной полости, декомпрессию билиарного тракта. На втором этапе устраняли причину перфорации, выполняли резекционно-реконструктивное оперативное вмешательство. Летальность составила 5,6%. Заключение. Спонтанная перфорация в системе желчных протоков – редкое патологическое состояние, являющееся осложнением заболеваний органов гепатопанкреатодуоденальной зоны. Оно требует повышенной осведомленности от абдоминальных хирургов. Основа хирургической стратегии – правильно установленный диагноз и поэтапная тактика лечения, что позволяет уменьшить частоту осложнений и летальность.

Ключевые слова:
печень, разрыв желчных протоков, спонтанная перфорация, гепатобилиарная хирургия, экстренная хирургия, скопление желчи

Литература:
1. Masroor M., Sarwari M.A. Spontaneous common bile duct perforation in full term pregnancy: a rare case report and review of literature. BMC Surg. 2021; 21 (1): 239. https://doi.org/10.1186/s12893-021-01230-2
2. Kitagawa S., Hatayama K., Okamura K. Spontaneous perforation of the subvesical bile duct. Endoscopy. 2018; 50 (6): E140-E141. https://doi.org/10.1055/a-0573-0685
3. Kang S.B., Han H.S., Min S.K., Lee H.K. Nontraumatic perforation of the bile duct in adults. Arch. Surg. 2004; 139 (10): 1083-1087. https://doi.org/10.1001/archsurg.139.10.1083
4. Bhattacharjee P.K., Choudhury D., Rai H., Ram N., Chattopadhyay D., Roy R.P. Spontaneous perforation of common bile duct: a rare complication of choledocholithiasis. Indian J. Surg. 2009; 71 (2): 92-94. https://doi.org/10.1007/s12262-009-0024-5
5. Singh H., Gupta R., Dhaliwal L., Singh R. Spontaneous choledochal cyst perforation in pregnancy with co-existent chronic pancreatitis. BMJ Case Rep. 2014. https://doi.org/10.1136/bcr-2014-207183
6. Suzuki K., Hashimoto T., Osugi S., Toyota N., Omagari K., Tamura A. Spontaneous biloma resulting from intrahepatic bile duct perforation coexisting with intrahepatic cholelithiasis and cholangiocarcinoma: a case report and literature review. Am. J. Case Rep. 2020; 21: e926270. https://doi.org/10.12659/AJCR.926270
7. Kaplan M. A case report of an ampullary tumor presenting with spontaneous perforation of an aberrant bile duct and treated with total laparoscopic pancreaticoduodenectomy. World J. Surg. Oncol. 2012; 10: 1-5. https://doi.org/10.1186/1477-7819-10-142
8. Fukui T., Chochi T., Maeda T., Lee C., Wada Y., Ohashi M., Tashiro J., Arai M., Kurata M., Yoshida T., Konishi F. Biliary peritonitis caused by spontaneous bile duct rupture in the left triangular ligament of the liver after endoscopic sphincterotomy for choledocholithiasis. Case Rep. Gastroenterol. 2021; 15 (1): 53-61. https://doi.org/10.1159/000510932
9. Aydin U., Yazici P., Coker A. Spontaneous rupture of intrahepatic biliary ducts with biliary peritonitis. Indian J. Gastroenterol. 2007; 26 (4): 188-189. PMID: 17986751
10. Chung Y.K., Hwang S., Kim Y.I., Kang C.M., Ko G.Y., Kwon D.I., Lee S.K. Spontaneous rupture of intrahepatic bile duct following portal vein embolization in a patient with perihilarcholangiocarcinoma: a case of successful curative resection. Korean J. Hepatobiliary Pancreat. Surg. 2013; 17 (1): 42-47. https://doi.org/10.14701/kjhbps.2013.17.1.42
11. Batista-Castillo R., Gonzalez-Martinez S., Jorba-Martin R., Memba-Ikuga R., Mata-Sancho F., Gonzalez-Santin V., Bachs-Carre E., Barrios-Sanchez P. Biliary peritonitis secondary to spontaneous rupture of hepatic mesenchymalhamartoma. Rev. Esp. Enferm. Dig. 2013; 105 (6): 358-359. https://doi.org/10.4321/s1130-01082013000600008
12. Simion L., Straja D., Prunoiu V., Alecu M., Bratucu E. Choleperitoneum due to intrahepatic bile duct rupture - case report. Chirurgia (Bucur). 2014; 109 (4): 542-545. PMID: 25149621
13. Sumer F., Kayaalp C., Karagul S., Ertugrul I., Yagci M.A., Onur A. Case report of non-traumatic spontaneous intrahepatic bile duct rupture in an adult. Int. J. Surg. Case Rep. 2016; 21: 104-106. https://doi.org/10.1016/j.ijscr.2016.02.015
14. Georgiou G.K., Tsili A., Batistatou A., Papoudou-Bai A., Papadopoulos G., Fatouros M., Glantzounis G.K. Spontaneous biloma due to an intrahepatic cholangiocarcinoma: an extremely rare case report with long term survival and literature review. Ann. Med. Surg. 2017; 14: 36-39. https://doi.org/10.1016/j.amsu.2017.01.017
15. Okamura Y., Nishitai R., Sasaki N., An H., Fushitani M., Ota T., Morioka M., Kawaguchi K., Konishi S., Hamasu S., Manaka D. Intrahepatic bile duct rupture associated with IgG4-related sclerosing cholangitis presenting hepatic inflammatory pseudotumor. Clin. J. Gastroenterol. 2021; 14 (5): 1530-1535. https://doi.org/10.1007/s12328-021-01487-3
16. Gomez-Torres G.A., Rodriguez-Navarro F.M., Lopez-Lizarraga C.R., Bautista-Lopez C.A., Ortega-Garcia O.S., Becerra-Navarro G., Aguila-Barragan A., Ploneda-Valencia C.F. Acute abdomen secondary to a spontaneous perforation of the biliary tract, a rare complication of choledocholithiasis. Int. J. Surg. Case Rep. 2017; 41: 255-258. https://doi.org/10.1016/j.ijscr.2017.10.040
17. Оarmin R., Alwi R.I., Shaharuddin S., Salleh K.M., Gunn A. Common bile duct perforation due to tuberculosis: a case report. Asian J. Surg. 2004; 27 (4): 342-344. https://doi.org/10.1016/S1015-9584(09)60065-8
18. Lochan R., Joypaul B.V. Bile peritonitis due to intra-hepatic bile duct rupture. World J. Gastroenterol. 2005; 11 (42): 6728-6729. https://doi.org/10.3748/wjg.v11.i42.6728
19. Dabbas N., Abdelaziz M., Hamdan K., Stedman B., Abu H.M. Gallstone-induced perforation of the common bile duct in pregnancy. HPB Surg. 2008; 2008: 174202. https://doi.org/10.1155/2008/174202
20. Mizutani S., Yagi A., Watanabe M., Maejima K., Komine O., Yoshino M., Ogata M., Hoshino A., Suzuki H., Tokunaga A., Uchida E. T tube drainage for spontaneous perforation of the extrahepatic bile duct. Med. Sci. Monit. 2011; 17 (1): CS8-CS11. https://doi.org/10.12659/msm.881317
21. Paramhans D., Shukla S., Grover J. Spontaneous perforation of the common bile duct in an adult. Indian J. Surg. 2013; 75 (Suppl 1): 376-378. https://doi.org/10.1007/s12262-012-0512-x
22. Pulat H., Karakose O., Benzin M.F., Sabuncuoglu M.Z., Cetin R. A rare cause of acute abdomen: spontaneous common hepatic duct perforation. Ulus Travma Acil. Cerrahi Derg. 2016; 22 (1): 103-105. https://doi.org/10.5505/tjtes.2015.95142
23. Subasinghe D., Udayakumara E.A., Somathilaka U., Huruggamuwa M. Spontaneous perforation of common bile duct: a rare presentation of gall stones disease. Case Rep. Gastrointest. Med. 2016; 2016: 1-3. https://doi.org/10.1155/2016/5321304
24. McGrath B.A., Singh M., Singh T., Maguire S. Spontaneous common bile duct rupture in pregnancy. Int. J. Obstet. Anesth. 2005; 14 (2): 172-174. https://doi.org/10.1016/j.ijoa.2004.10.006
25. Endeman H., Ligtenstein D.A., Oudemans-van Straaten H.M. Spontaneous perforation of the cystic duct in streptococcal toxic shock syndrome: a case report. J. Med. Case Rep. 2008; 2: 338. https://doi.org/10.1186/1752-1947-2-338
26. Khanna R., Agarwal N., Singh A.K., Khanna S., Basu S.P. Spontaneous common bile duct perforation presenting as acute abdomen. Indian J. Surg. 2010; 72 (5): 407-408. https://doi.org/10.1007/s12262-010-0113-5
27. Laway M.A., Bakshi I.H., Shah M., Paray S.A., Malla M.S. Biliary peritonitis due to spontaneous perforation of choledochus: a case report. Indian J. Surg. 2013; 75 (Suppl 1): 96-98. https://doi.org/10.1007/s12262-011-0351-1
28. Varun N., Elahi A.A., Gupta N., Nigam A. Ruptured choledochal cyst during early pregnancy with successful fetomaternal outcome. BMJ Case Rep. 2018; 2018: bcr201822435. https://doi.org/10.1136/bcr-2018-224357
29. Lee J.H., Suh J.I. A case of infected biloma due to spontaneous intrahepatic biliary rupture. Korean J. Intern. Med. 2007; 22 (3): 220-224. https://doi.org/10.3904/kjim.2007.22.3.220
30. Lee H.K., Han H.S., Lee J.H., Min S.K. Nontraumatic perforation of the bile duct treated with laparoscopic surgery. J. Laparoendosc. Adv. Surg. Tech. A. 2005; 15 (3): 329-332. https://doi.org/10.1089/lap.2005.15.329
31. Akhtar M.A., Bandyopadhyay D., Montgomery H.D., Mahomed A. Spontaneous idiopathic subcapsularbiloma. J. Hepatobiliary Pancreat. Surg. 2007; 14 (6): 579-581. https://doi.org/10.1007/s00534-006-1182-5
32. Mushtaque M., Farooq Mir M., Nazir P., Khan P.S., Dadu V., A Dar L., A Dar R., A Khanday S. Spontaneous hepatic subcapsularbiloma: report of three cases with review of the literature. Turk. J. Gastroenterol. 2012; 23 (3): 284-289. https://doi.org/10.4318/tjg.2012.0346
33. Della Valle V., Eshja E., Bassi E.M. Spontaneous biloma: a case eport. J. Ultrasound. 2013; 18 (3): 293-296. https://doi.org/10.1007/s40477-013-0053-6
34. Syal D., Mittal P. A rare cause of bile duct rupture. Indian J. Gastroenterol. 2014; 33 (4): 393-394. https://doi.org/10.1007/s12664-013-0351-0
35. Chao C.T. Sclerotherapy as a palliative treatment for spontaneous huge biloma. Intern. Emerg. Med. 2014; 9 (5): 597-598. https://doi.org/10.1007/s11739-014-1052-0
36. Huda F., Naithani M., K Singh S., Saha S. Ascitic fluid/serum bilirubin ratio as an aid in preoperative diagnosis of choleperitoneum in a neglected case of spontaneous common bile duct perforation. Euroasian J. Hepatogastroenterol. 2017; 7 (2): 185-187. https://doi.org/10.5005/jp-journals-10018-1246
37. Ticehurst F.M., Hutchins R.R., Davidson B.R. Spontaneous perforation of the bile duct. HPB (Oxford). 2001; 3 (4): 285-287. https://doi.org/10.1080/136518201753335494
38. Kaffes A.J., Alrubaie A., Hollands M., Williams S.J., Bourke M.J. Spontaneous bile leak 6 years after uneventful cholecystectomy. Gastrointest. Endosc. 2003; 57 (7): 985-987. https://doi.org/10.1016/s0016-5107(03)70059-5
39. Trivedi P.J., Gupta P., Phillips-Hughes J., Ellis A. Biloma: an unusual complication in a patient with pancreatic cancer. World J. Gastroenterol. 2009; 15 (41): 5218-5220. https://doi.org/10.3748/wjg.15.5218
40. Karvonen J., Gullichsen R., Salminen P., Laine S., Gronroos J.M. Successful endoscopic treatment of spontaneous perforation of the common hepatic duct. Endoscopy. 2009; 41 Suppl 2: E224-5. https://doi.org/10.1055/s-0029-1214926
41. Bas G., Okan I., Sahin M., Ery?lmaz R., Is?k A. Spontaneous biloma managed with endoscopic retrograde cholangio-pancreatography and percutaneous drainage: a case report. J. Med. Case Rep. 2011; 5: 3. https://doi.org/10.1186/1752-1947-5-3
42. Garg P.K., Jain B.K., Pandey S.D., Rathi V., Puri A.S. Simultaneous non-traumatic perforation of the right hepatic duct and gallbladder: an atypical occurrence. Malays. J. Med. Sci. 2012; 19 (3): 77-80. PMID: 23610553
43. Yousaf M.N., D'Souza R.G., Chaudhary F., Ehsan H., Sittambalam C. Biloma: a rare manifestation of spontaneous bile leak. Cureus. 2020; 12 (5): e81166. https://doi.org/10.7759/cureus.8116
44. Amberger M., Burton N., Tissera G., Baltazar G., Palmer S. Spontaneous common bile duct perforation - a rare clinical entity. Int. J. Surg. Case Rep. 2018; 46: 34-37. https://doi.org/10.1016/j.ijscr.2018.03.030
45. Arramon M., Sciarretta M., Correa G.J., Yantorno M., Redondo A., Baldoni F., Tufare F. Spontaneous biloma secondary to choledocholithiasis. ACG Case Rep. J. 2021; 8 (6): e00620. https://doi.org/10.14309/crj.0000000000000620
46. Brown S., Giuseppucci P., Esper C. Rare reported left hepatic subcapsular biloma and management. Case Rep. Surg. 2017; 2017: 8609185. https://doi.org/10.1155/2017/8609185
47. Sachdeva S., Sonika U., Dalal A., Sethi S.S., Kumar M. Spontaneous giant biloma resulting from multifocal left hepatic duct perforation. Indian J. Gastroenterol. 2022; 41 (4): 415-416. https://doi.org/10.1007/s12664-021-01154-y
48. Takahashi K., Okabe Y., Orino A., Imai Y., Yazumi S., Chiba T. Spontaneous rupture of a biliary diverticulum in the distal common bile duct, with formation of a retroperitoneal biloma. Gastrointest. Endosc. 2005; 61 (6): 783-787. https://doi.org/10.1016/s0016-5107(05)00124-0
49. Yasar N.F., Yasar B., Kebapc? M. Spontaneous common bile duct perforation due to chronic pancreatitis, presenting as a huge cystic retroperitoneal mass: a case report. Cases J. 2009; 2: 6273. https://doi.org/10.4076/1757-1626-2-6273
50. Stipsanelli E., Valsamaki P., Tsiouris S., Arka A., Papathanasiou G., Ptohis N., Lahanis S., Papantoniou V., Zerva C. Spontaneous rupture of a type IVA choledochal cyst in a young adult during radiological imaging. World J. Gastroenterol. 2006; 12 (6): 982-986. https://doi.org/10.3748/wjg.v12.i6.982
51. Fragulidis G.P., Marinis A.D., Anastasopoulos G.V., Vasilikostas G.K., Koutoulidis V. Management of a ruptured bile duct cyst. J. Hepatobiliary Pancreat. Surg. 2007; 14 (2): 194-196. https://doi.org/10.1007/s00534-006-1128-y
52. Bediako-Bowan A.A., Dakubo J.C., Asempa M. Spontaneous extra-hepatic bile duct perforation postpartum. Ghana Med. J. 2013; 47 (4): 204-207. PMID: 24669027
53. IIshii K., Matsuo K., Seki H., Yasui N., Sakata M., Shimada A., Matsumoto H. Retroperitoneal biloma due to spontaneous perforation of the left hepatic duct. Am. J. Case Rep. 2016; 17: 264-267. https://doi.org/10.12659/ajcr.897612
54. Brady R.R., McAteer E., Weir C.D. Biliscrotum and retroperitoneal biloma: spontaneous rupture of the biliary system presenting as an incarcerated inguinal hernia. Ulster Med. J. 2006; 75 (1): 85-87. PMID: 16457410
55. O'Neill A., O'Sullivan M.J., McDermott E. Spontaneous common bile duct rupture in a pregnant female - a rare cause of peritonitis. Eur. J. Obstet. Gynecol. Reprod. Biol. 2009; 142 (1): 81. https://doi.org/10.1016/j.ejogrb.2008.09.002
56. Peng C., Chubb D., Thomson B.N.K., Miller F.J. A case of spontaneous bile leak. ANZ J. Surg. 2015; 88 (5): E458-E459. https://doi.org/10.1111/ans.13409
57. Gundara J.S., Jancewicz S. Spontaneous biliary peritonitis, or delayed bile leak? Int. J. Surg. Case Rep. 2011; 2 (6): 166-167. https://doi.org/10.1016/j.ijscr.2011.05.002
58. Hamura R., Haruki K., Tsutsumi J., Takayama S., Shiba H., Yanaga K. Spontaneous biliary peritonitis with common bile duct stones: report of a case. Surg. Case Rep. 2016; 2 (1): 103. https://doi.org/10.1186/s40792-016-0234-6
59. Sakamoto R., Kai K., Hiyoshi M., Imamura N., Yano K., Hamada T., Nishida T., Kawano F., Sakurahara D., Uchise Y., Yamamoto K., Kataoka H., Nanashima A. Spontaneous common bile duct perforation due to choledocolithiasis accompanied with pancreaticobiliary maljunction in an adult: a case report. Surg. Case Rep. 2015; 7 (1): 205. https://doi.org/10.1186/s40792-021-01290-9

Spontaneous perforation in the bile duct system

Aim. To evaluate different therapeutic and diagnostic approaches in spontaneous bile duct perforation. Materials and methods. The present study involved the reports on spontaneous perforations in the bile duct system, published from 01.01.2000 to 01.06.2022 and selected by structured search in PubMed/Medline database. Results. As a result, 58 articles describing 71 patients were selected for the study. The most frequent symptoms of the disease included abdominal pain (92.9%), fever (39.4%), and jaundice (33%). The provisional diagnosis was made correctly in 52.1% of cases. The development of the disease was most often associated with choledocholithiasis (38%). Bile ducts perforation of the left hepatic lobe was revealed in 40.6% of cases, perforation of the common bile duct – in 35.5%. Bile duct perforation resulted in peritonitis in 42.2% of patients and bile accumulation or abscess in 30.9%. Encapsulated and intrahepatic accumulation of bile was found in 18.3% of cases. Management of perforations with development of encapsulated and intrahepatic bile accumulation included combined treatment, embracing percutaneous transhepatic drainage and endoscopic methods. Perforation of bile ducts with development of extensive forms of the disease required two-stage treatment. The first stage involved lavage of the abdominal cavity and decompression of the biliary tract. The second stage involved resective and reconstructive surgery to eliminate the cause of the perforation. The mortality rate was 5.6%. Conclusion. Spontaneous perforation in the bile duct system is a rare pathological state appeared as a complication of hepatopancreaticoduodenal diseases. Its management requires greater awareness of abdominal surgeons. The surgical strategy is based on correctly diagnosed and staged treatment tactics, which allows the incidence of complications and mortality rate to be reduced.

Keywords:
liver, bile duct rupture, spontaneous perforation, hepatobiliary surgery, emergency surgery, bile accumulation