Imaging of spontaneous biliary perforation in neonates: focus on ultrasound findings with a review of the literature

Šljivić, Maja; Arih, Kristina; Glušič, Mojca; Ključevšek, Damjana

doi:10.15557/jou.2025.0035

Figures & Tables

Ultrasound findings suggestive of biliary perforation in the first patient: A. normal gallbladder wall thickness without intraluminal stones, thickened hyperechoic duodenal wall (black arrow) and a pouch of fluid collection (arrowheads), B. small hyperechoic formation with distal shadowing at the end of the common duct suspicious for a small stone (arrow), no bile duct dilatation, c) localized fluid collection (arrowheads)

Ultrasound findings suggestive of biliary perforation in second patient on admission: A. and B. beginning of the septated collection in the hepatoduodenal region (arrowheads), concentric thickening of the distal common biliary duct (arrow), and contracted gallbladder (empty arrowhead), C. extension of the fluid collection (arrowheads) down to the level of the right kidney (empty arrow) in the anterior pararenal space

Use of ultrasound in neonatal cases of spontaneous biliary perforation: Legend: US – ultrasound; SBP – spontaneous gallbladder perforation

Literature review of neonatal cases of spontaneous gallbladder perforation

Article	Gender	Age (days)	Cause	Location of perforation	Diagnostic/Therapeutic methods (chronological)	Ultrasound findings (signs)	Was US diagnostic?
Mishra et al., 2024⁽²⁰⁾	M	28	Idiopathic	Proximal part of the CBD	Paracentesis, HIDA, MRCP, US-guided transcutaneous drain	–	–
Takrouneyet al., 2023⁽²⁶⁾	M	5	Idiopathic	GB infundibulum	US, abdominal X-ray, laparotomy	NONSPECIFIC: minimal free intraperitoneal fluid with no biloma or subhepatic abscess formation.	Nondiagnostic
Jeniga et al., 2022⁽¹⁹⁾	F	8	Idiopathic	GB fundus	Abdominal X-ray, US, laparotomy	SPECIFIC: perforation at the fundus (of the gallbladder). INDIRECT: contracted gall bladder, hyperechoic foci noted in the gallbladder suggestive of gallbladder calculi, pericholecystic collection.	Diagnostic
Sharif et al., 2021⁽²¹⁾	X	11	Idiopathic	GB fundus	US*, laparotomy	SPECIFIC: suspicion of perforation in the posterior wall of the gall bladder. NONSPECIFIC: hepatomegaly and moderate debris ascites were noted.	Diagnostic
Leung et al., 2020⁽²²⁾	F	21	Idiopathic	GB infundibulum	US, HIDA, MRCP, laparotomy	INDIRECT: tortuous area of echogenicity adjacent to the cystic duct NONSPECIFIC: ascites.	Diagnostic
Tavakoli et al., 2019⁽¹⁸⁾	F	12	Idiopathic	GB posterior wall	US, HIDA, abdominal CT, laparotomy	INDIRECT: contracted gallbladder.	Diagnostic
Hopper et al., 2018⁽⁶⁾	M	21	Idiopathic	The confluence of the cystic and CBD	US, HIDA, laparotomy	NONSPECIFIC: mild to moderate ascites (normal liver and gallbladder with no dilation of the intra- or extrahepatic ducts).	Nondiagnostic
Naik et al., 2018⁽²³⁾	M	4	Idiopathic	GB body	Abdominal X-ray, US, laparotomy	INDIRECT: presence of a small collection in the subhepatic region. NONSPECIFIC: dilated bowel loops.	Diagnostic
	M	5	Prematurity (born at 8 months of gestational age)	GB body	Abdominal X-ray, US, laparotomy	INDIRECT: subhepatic collection NONSPECIFIC: presence of dilated bowel loops.	Diagnostic
	M	11	Ileus (intestinal adhesions and obstruction)	GB body	Abdominal X-ray, US, laparotomy	NONSPECIFIC: dilated small bowel loops with sluggish peristalsis and a collapsed colon, hinting at a possible distal ileal obstruction but with no frank malrotation of the gut.	Nondiagnostic
Bjørn, et al., 2017⁽⁶⁾	M	20	Delivery trauma or neonatal asphyxia	Angle between the cystic duct and the common bile duct	US, abdominal X-ray, laparotomy	NO ABNORMALITIES	Nondiagnostic
Beltran et al., 2017⁽⁸⁾	F	7	Necrotizing enterocolitis	Extrahepatic bile duct	Abdominal X-ray, US, laparotomy	NONSPECIFIC: air in the peritoneal cavity, distributed in the left hypochondrium towards the umbilical region. Liquid between loops. Advanced necrotizing enterocolitis was detected.	Nondiagnostic
Reyna-Sepulveda et al., 2016⁽¹⁾	F	14	Idiopathic	CBD	US, PTC, laparotomy	INDIRECT: a poorly-defined collection of 7.9 mL in a sub-hepatic location. NONSPECIFIC: generalized ascites (no evidence of dilation of the bile duct or presence of a choledochal cyst).	Diagnostic
Sheets et al., 2015⁽²⁵⁾	M	7	Prematurity (born at gestation of 26 weeks)	GB fundus	Abdominal X-ray, laparotomy	/	/
Chen et al., 2012⁽¹⁴⁾	F	10	Biliary perforation 6 days after UTI sepsis	Bifurcation of the common hepatic junction (anterior wall)	US*, paracentesis, laparotomy	NONSPECIFIC: massive ascites.	Nondiagnostic
Livesey et al., 2007⁽¹³⁾	M	27	Idiopathic	Proximal part of CBD	US*, laparotomy	NONSPECIFIC: fluid collection in the lesser sac.	Nondiagnostic
Livesey et al., 2007⁽¹³⁾	M	18	Idiopathic	CBD	US, HIDA, laparotomy	NONSPECIFIC: free intraperitoneal fluid without any evident masses.	Nondiagnostic
Sahnoun et al., 2006⁽¹⁷⁾	M	27	Idiopathic	Proximal part of CBD	US, abdominal CT, laparotomy	INDIRECT: hypoechogenic multicystic fluid collection localized in the porta hepatis.	Diagnostic
Sahnoun et al., 2006⁽¹⁷⁾	M	19	Idiopathic	CBD	US*, CT-guided needle aspiration, laparotomy	INDIRECT: a localized 3×1.5 cm fluid collection in the hilum of the liver with mild dilatation of the main bile duct.	Diagnostic
Gull et al., 2005⁽¹⁵⁾	M	3	Prematurity (born at gestation of 29 weeks)	GB neck	Abdominal X-ray, laparotomy	/	/
Kumar et al., 2001⁽¹⁶⁾	M	2	Idiopathic	The site of perforation is not explicitly identified	US, abdominal X-ray, barium meal, laparotomy	NONSPECIFIC: mild hepatomegaly, no dilatation of the intrahepatic bile ducts.	Nondiagnostic
Nambirajan et al., 2000⁽²⁴⁾	X	3	Operated for diaphragmatic eventration through the chest	GB neck	US, barium meal, laparotomy	NONSPECIFIC: suggestive of extrinsic compression (biloma on US) in the region of the pylorus.	Nondiagnostic
Hirigoyen et al., 1995⁽²⁷⁾	F	24	Idiopathic	CBD (anterior wall)	Abdominal X-ray, laparotomy	/	/

Imaging of spontaneous biliary perforation in neonates: focus on ultrasound findings with a review of the literature

Figures & Tables

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Fig. 3.

Literature review of neonatal cases of spontaneous gallbladder perforation

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