Idiopathic spontaneous perforation of the common bile duct in an adult

Spontaneous perforation of the common bile duct (SPCBD) is an extremely rare clinical entity in adults, typically idiopathic in origin, though potential causes include distal obstruction, reflux of pancreatic secretions, intramural vascular thrombosis, infection, or direct erosion by stones. We present a rare case of idiopathic SPCBD in an adult who had undergone a previous cholecystectomy. Imaging findings revealed biliary dilatation and a fluid collection extending to the paracolic gutter, posing a challenge in determining whether it was a collection related to pancreatitis or other cause. Laparoscopy for peritonitis revealed a biliary collection, which was successfully drained. Following this, an Endoscopic Retrograde Cholangio-Pancreatography identified a bile leak from the common bile duct, leading to a diagnosis of idiopathic SPCBD. The patient was successfully managed with biliary stenting. This case emphasizes the critical role of multidisciplinary team discussions and the value of collaborative approaches in treating such complex conditions.