DOI: https://doi.org/10.36347/sasjs.2025.v11i10.018

Pages: 1032-1036

Spontaneous biliary perforation in infancy is a rare but important cause of surgical jaundice, with management strategies ranging from conservative drainage to complex biliary reconstruction. The condition is characterized by bile leakage into the peritoneal cavity without an identifiable cause and is often associated with significant morbidity if not promptly recognized. We report the case of a 4-month-old female who presented with progressive jaundice, abdominal distension, lethargy, and failure to thrive. She was born preterm at 35 weeks with low birth weight and had prolonged neonatal hospitalization for sepsis and jaundice. On referral, she was severely malnourished with tense abdominal distension. Laboratory evaluation revealed obstructive jaundice with preserved hepatic function, while ultrasound and hepatobiliary scintigraphy confirmed biliary ascites and active bile leak. Exploratory laparotomy revealed free bile in the peritoneal cavity and a tiny calculus at the leak site; however, anatomy could not be clearly defined due to inflammation. External drainage was performed. Postoperatively, she required prolonged parenteral nutrition and drain repositioning for loculated collections. Gradual clinical and biochemical improvement was noted, with eventual clearance of jaundice, normalization of stool color, and weight gain. She was thriving at 3-month follow-up. This case highlights the diagnostic challenges of spontaneous biliary perforation in infants and supports the role of timely surgical drainage as a safe and effective initial management strategy, avoiding complex biliary reconstruction in critically ill children.