# A Unique Presentation of Acute Biliary Ascites Due to Spontaneous Biliary Duct Perforation With Bowel Obstruction: A Case Report

## TL;DR

A 14-month-old child presented with rare biliary ascites due to a spontaneous biliary duct perforation and bowel obstruction, successfully managed with non-surgical treatment.

## Contribution

This case report presents a rare pediatric case of spontaneous biliary duct perforation with bowel obstruction and partial situs inversus.

## Key findings

- Bilious fluid confirmed biliary ascites via diagnostic paracentesis.
- Bowel obstruction was relieved with rectal stimulation.
- Non-surgical management improved the patient's prognosis.

## Abstract

Biliary ascites due to spontaneous biliary duct perforation is a rare case presentation usually seen in the paediatric age group of 6-36 months. We are presenting the case of a 14-month-old baby with abdominal distention associated with abdominal pain, vomiting, fever, and a history of no passage of stools. Upon examination, the abdomen was tense and tender. On radiological investigations, gross free fluid was present in the abdominal cavity along with bowel obstruction and partial situs inversus of the spleen and stomach. The bowel obstruction was relieved by rectal stimulation, after which oral feeds were well tolerated. Bilious fluid was found on diagnostic paracentesis, confirming the diagnosis. The patient was managed further by broad-spectrum antibiotics and drainage of the free fluid. The management ranges from conservative treatment to Roux-en-Y anastomosis. A non-surgical diagnosis is uncommonly seen and helps improve the patient's prognosis if detected early. This case report highlights the importance of early diagnosis and non-surgical treatment modality in critical patients.