Spontaneous Rupture of the Intrahepatic Bile Duct due to Carcinoma of the Ampulla of Vater: A Case Report

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We reported the first case of spontaneous rupture of the intrahepatic bile duct due to carcinoma of the ampulla of Vater. The patient was a 67-year-old male and he visited the hospital in a pre-shock state. He was diagnosed as panperitonitis and an emergency operation was performed on that day. A laparotomy revealed ascetic fluid containing bile to be retained in the abdominal cavity. Intraoperative cholangiography showed a complete obstruction of the lower common bile duct and the rupture of the intrahepatic (S3) bile duct. A lateral segmentectomy of the liver was performed, followed by T-tube biliary drainage. A two-stage checkup/operation was planned for treatment of the obstruction of the common bile duct. Endoscopic retrograde cholangiography (ERC) performed postoperatively revealed a mass in the ampulla of Vater causing a marked stricture of the common bile duct in that region. A pylorus-preserving pancreaticoduodenectomy including a regional lymphadenectomy was performed about 5 months after the initial operation. There has been no other reports documenting a two-stage operation for the resection of a malignant tumor after treatment with bile peritonitis . The avoidance of sepsis and multiple organ failure via surgical treatment directed against bile peritonitis at the appropriate time is considered optimal strategy to save the life of a patient with this condition.