PMC3779402_01
Case1: One-and-half-year-old male child diagnosed as having spontaneous biliary peritonitis. (a) Contrast enhanced computed tomography axial section shows dilated gall bladder (A) and dilated common bile duct (B), (b) Contrast enhanced computed tomography axial section demonstrates free fluid (C), (c) Contrast enhanced computed tomography axial section multiplanar reconstructed coronal image demonstrates dilated gall bladder (A), (d) Contrast enhanced computed tomography axial section multiplanar reconstructed coronal image demonstrates dilated common bile duct (B) and free fluid (C).
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F1
A disproportionately large fluid collection was seen in left posterior peri-hepatic space [Figures 1 and 2].
Case 1: One-and-half-year-old male child diagnosed as having spontaneous biliary peritonitis. Magnetic resonance cholangio-pancreatography image shows grossly dilated common bile duct (A) and dilatation of intra hepatic biliary radicals (B).
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F2
A disproportionately large fluid collection was seen in left posterior peri-hepatic space [Figures 1 and 2].
Case 1: One-and-half-year-old male child diagnosed as having spontaneous biliary peritonitis. Photograph taken during surgery shows distended gall bladder (A), dilated bile duct (B), and bile stained gastro-hepatic omentum (C) suggestive of biliary leak.
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F3
Exploratory laparotomy with adhesionolysis and cholecystectomy with Roux-en-Y hepatico-jejunostomy was performed [Figure 3].
PMC3779402_02
Case 2: Three-year-old male child with abdominal pain and high-grade intermittent fever, mild jaundice without cholestatic features, vomiting, and a lump in the right upper abdomen later diagnosed as having spontaneous biliary peritonitis. (a) Contrast enhanced computed tomography axial section demonstrates dilated gallbladder crossing the midline (A), free fluid in left sub hepatic space (B), and dilated intra hepatic biliary radicals, (b) Contrast enhanced computed tomography axial section multiplanar reconstructed coronal image demonstrates dilated GB crossing midline (A) and free fluid in pelvis (D).
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This led to a revised diagnosis of biliary perforation and subsequently a Computed Tomography (CT) scan was done [Figure 4]. A small collection of fluid was seen in the posterior left peri-hepatic space around the neck of GB along with some free fluid in right paracolic gutter, indicative of localized biliary perforation [Figure 4a and b].
Case 2. Three-year-old male child diagnosed as having spontaneous biliary peritonitis. T2-weighted fat suppressed magnetic resonance cholangio- Pancreatography image shows dilated gallbladder (A) with stranding near gall bladder neck (B).
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MRI of upper abdomen done about 7 days later [Figure 5] showed reduction in diameter of GB from 5 cm to approximately 2.8 cm.
Case 2: 3-year-old male child diagnosed as having spontaneous biliary peritonitis. (a) Follow-up T2-weighted magnetic resonance cholangio- Pancreatography image shows normally distended Gall Bladder (A), (b) Follow-up T2-weighted fat suppressed cholangio-pancreatography image of case 2 shows normal caliber common Bile duct (B).
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A follow-up MRI done a year-and-a-half later showed partially distended GB in similar location, and persisting dilatation of central hepatic ducts and common hepatic duct, which tapered smoothly into a normal caliber CBD [Figure 6a and b].