Bile refeeding in spontaneous bile duct perforation in a neonate: A case report

There is no true consensus on the optimal management strategy for spontaneous bile duct perforation in neonates, but previous studies favor surgical drainage over primary repair. Management of subsequent high-volume biliary drainage has not yet been reported, particularly bile refeeding after surgical drain placement. We present a case of spontaneous bile duct perforation in a previously healthy 16-day-old female who presented with abdominal distension, acholic stools, and direct hyperbilirubinemia. Intraoperative cholangiogram demonstrated a perforation at the proximal common bile duct, which was patched with omentum. A surgical drain was placed in the sub-hepatic space. She recovered well and was discharged home, but continued to have high volumes of bile drainage. She required readmission due to dehydration, electrolyte derangement, and weight loss. Upon readmission, a nasogastric feeding tube was placed, and she was refed bile from the drain every 8 hours while continuing to breast and bottle-feed. Over the next five days, drain output decreased and she was again discharged home. At one-week follow up, there was no additional bile drainage, she was well-appearing, and gaining weight. The drain was removed in clinic. She was subsequently seen approximately four months from her operation at which time she was well and thriving. Intraoperative cholangiogram and drain placement are safe and effective for spontaneous bile duct perforation. Bile refeeding can be used in the setting of excessive biliary losses after surgical drainage for neonatal spontaneous bile duct perforation and may decrease bile drainage.