Choledocholithiasis causing cystic duct perforation in an infant: A case report

Infant choledocholithiasis causing a distal obstruction resulting in a cystic duct perforation is a rare finding especially in infants with no underlying risk factors. A 5-month-old, previously healthy male with poor weight gain presented with worsening irritability and abdominal pain. Laboratory studies on presentation to the emergency department were notable for a leukocytosis to 15.14 x 10 3 mcL and total bilirubin of 1.7 mg/d. Imaging (ultrasound, x-ray, computed tomography) showed moderate intra-abdominal free fluid, no identifiable gallstones, and non-obstructive gaseous bowel distension. We decided to perform a diagnostic laparoscopy which revealed bilious ascites. An exploratory laparotomy was performed; a distal common bile duct stone and perforation of the cystic duct was noted with intraoperative cholangiogram. An open, trans-cystic common bile duct exploration was performed to clear the distal obstruction and cholecystectomy and ligation of the cystic duct proximal to the perforation was performed. Patency of biliary tract was confirmed with repeat intraoperative cholangiogram. The patient had an uncomplicated post-operative course with resumption of oral liquids on post-operative day 4. He was discharged on post-operative day 11; his outpatient follow-up is significant for weight gain and no symptom recurrence. Cystic duct perforation is a potential complication of choledocholithiasis in infants.