Spontaneous hepatic duct perforation in pregnancy: a case report and review of the literature

Spontaneous perforation of the hepatic duct is a rare disease, and occurrence during pregnancy is even rarer. Treatment during pregnancy is crucial for both the mother and fetus. However, the treatment is a subject of controversy. We will discuss the case of an 18-year-old G1P1, 31 weeks pregnant, who showed acute onset of abdominal pain with peritoneal signs. She was taken to the operating room for exploratory laparotomy and was discovered to have a perforation of the common hepatic duct. Several factors thought to have caused spontaneous rupture of the bile tract were present: biliary calculi, infection, vessel thrombosis and pregnancy. The patient underwent a cholecystectomy, choledochotomy with removal of gallstones, repair of the perforation and placement of a T-tube. The postoperative course passed without problems for the mother and fetus. There were no complications, and the woman successfully carried her pregnancy to term. We conclude that the treatment of this unique and highly dangerous complication can be applied with an excellent outcome. The mechanism in this rare condition is discussed and reviewed.