成人肝內膽管自發性破裂十分罕見。大部分病人通常會有結石或是外傷病史，我們報告一位七十三歲男性，被診斷為肝內膽管自發性破裂併膽汁↑生腹膜炎，在經過本院急診科、腸胃科及放射科醫師共同努力下，成功治癒出院。此病人再經過本院十一個月來的追蹤，其病況及影像學上並無復發跡象。在此我們回顧以往的文獻，同時討論此病的特殊表現及必須考慮的鑑別診斷。並且讓所有急診醫護人員了解此病須快速診斷及治療以期降低困併發休克產生之死亡。

A 72-year-old Taiwanese male presented with a short history of fever and abdominal pain. The symptoms were shown to be due to perforation of his intra-hepatic duct (S5). We inserted a 7.4 Fr plastic stent into common bile duct and the symptoms subsided. The patient is well at 11 months follow-up. Bile stasis, inflammation, infection, biliary calculi, mural necrosis, and/or increased ductal pressure may have caused the perforation of the intra-hepatic duct. Spontaneous perforation of the intra-hepatic duct remains an exceedingly rare entity.