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Spontaneous perforation of the bile duct is a rare but well documented condition of infants. Six infants are described, five presenting within 2 months of birth without apparent antecedent factors and one associated with an ‘acquired’ type I biliary atresia at 8 months. All infants underwent definitive surgery, which included decompression of the biliary tree with cholecystenterostomy or T tube drainage. There was no morbidity or mortality associated with such surgical intervention.

A high incidence of infective complications followed choledochotomy and T-tube drainage when compared with closed biliary-tract procedures. Organisms cultured from infective sites were identical to those isolated from the T-tube in the postoperative period. Postoperative infection was associated with an increased morbidity in terms of length of hospital stay. As infection in these sites was independent of the presence of stones in the common bile-duct, complications would have been reduced if unnecessary exploration had been avoided. The routine use of operative cholangiography in the avoidance of these complications is discussed.