Bile peritonitis

T-tube drainage of the common bile duct choleperitoneum: Etiology and management

“…This bile results in a peritoneal inflammatory reaction, even when there is no co-incident infection. The bile leakage may be generalized throughout the peritoneal cavity or walled off; this accounts for the variable interval between leakage and diagnosis of choleperitoneum (within minutes or after an interval of days or even weeks) [4,25,26,[28][29][30][31]. The consequences of choleperitoneum may be serious due to:…”

“…• the irritant nature of bile (resulting in mucosal edema and alterations of the reticulo-endothelial system); • diminution of immune response caused by bile exposure [28,32]; • the local necrosing effect on adjacent organs, particularly when the bile is infected (lysis of mesothelial cells from prolonged exposure to bile salts) [28,30,32]; • the potential for multi-system failure due to peritoneal re-absorption of toxins and bile salts [25,[28][29][30]32]. …”

“…Signs of tachycardia, fever, abdominal distention and peritoneal irritation develop secondarily [7,11,13,16,26,30,31]. Mild jaundice visible on scleral examination may develop within hours due to transperitoneal re-absorption of bile [26,28]. Shock occurs if there is a delay in management.…”

“…If there is generalized bile peritonitis, fluid and electrolyte replacement plus broad spectrum antibiotic coverage to correct multi-organ failure should be followed by urgent surgical re-intervention. Surgery should include, at a minimum, peritoneal lavage and placement of drains adjacent to the fistula; if possible, a new cholangiography should be performed to rule out obstruction of the CBD, and to allow for external drainage, either with a new T-tube or a cystic duct drain [6,7,12,28,29]. Extensive sub-hepatic inflammatory adhesions may render exposure of the CBD impossible; this has led some authors to limit their re-intervention to lavage combined with sub-hepatic drainage or simple re-intubation of the leaking T-tube tract at a distance from the CBD [6,11,29] (Fig.…”

Emergency surgery for acute cholecystitis

“…Biliary peritonitis is associated with a mortality of between 50% and 75% according to Ellis & Cronin (1960) and Bell & Warden (1955). The two patients in this series with biliary peritonitis would have required urgent laparotomy even if they had been under the care of a surgeon who treated acute cholecystitis conservatively.…”