Rupture of the extrahepatic bile ducts should be considered in the differential diagnosis of bile peritonitis.
The following entities have been incriminated in bile duct perforation: (1) previous biliary tract surgery3,6,7,14,16; (2) abdominal trauma1,10,12,15; (3) vascular insufficiency with necrosis of the duct wall9; (4) choledochal diverticulum2; (5) erosion by tumor7; (6) acute pancreatitis.10,17 There is a further group of patients in whom the cause of perforation is unknown. This idiopathic group has been reported most frequently in early infancy and beyond middle age.8,11,13
At the Philadelphia General Hospital we have recently seen two patients with bile peritonitis due to spontaneous perforation of the common bile duct.
Report of Cases
—A 55-year-old Negro was admitted Nov. 7, 1956, from a local prison with abdominal "fullness" of three weeks' duration. He had lost 40 lb. during the preceding six months. There was associated