Biliary peritonitis: causes, symptoms, diagnosis, treatment

What diseases provoke bile peritonitis?

After cholecystectomy, the bile may leak from the bed of the bladder or the leaky bandaged vesicle duct. Increased pressure in the biliary tract, for example, in connection with the undeveloped stone of the common bile duct, increases the flow of bile, the accumulation of which around the biliary tract contributes to the development of their stricture.

After liver transplantation, it is possible that the bile flows from the area of the anastomosis of the bile ducts.

The empyema or gangrene of the gallbladder can be complicated by its rupture with the formation of an abscess. The formation of the spilled contents is promoted by the spikes formed earlier.

For traumatic causes bile peritonitis are stupid or gunshot wounds biliary tract and, rarely, the puncture of the gallbladder or enlarged intrahepatic duct with liver biopsy, as well as CHCHHG in patients with severe cholestasis. The leakage of bile is sometimes observed after an operating liver biopsy.

Spontaneous bile peritonitis can develop with severe prolonged mechanical jaundice without visible damage to the biliary tract. This phenomenon is explained by the rupture of small intrahepatic ducts.

Perforation of the common bile duct is very rare and is caused by the same causes as the perforation of the gallbladder: increased pressure in the biliary tract, erosion of the wall with a stone and its necrosis as a result of vascular thrombosis.

Sometimes jaundice of newborns is caused by spontaneous perforation of extrahepatic bile ducts, which is most often localized at the junction of the vesical and general hepatic ducts.

The pathogenesis of this process is unclear.

Symptoms of bile peritonitis

The severity of symptoms depends on the extent of bile in the abdomen and its infection. The presence of bile in the free abdominal cavity leads to severe shock. Yellow salts chemically irritate the peritoneum, which causes the exudation of large volumes of plasma into the ascites fluid. The outflow of bile is accompanied by the strongest diffuse pain in the abdomen. On examination, the patient is motionless, the skin is pale, low blood pressure, persistent tachycardia, dull rigidity, and diffuse tenderness during palpation of the abdomen are noted. Often paresis of the intestine develops, therefore, in patients with unexplained intestinal obstruction, it is always necessary to exclude cholangic peritonitis. A few hours later, secondary infection is attached, which is manifested by an increase in body temperature against the background of persistent pain in the abdomen and its soreness.

The results of laboratory studies are not indicative. Haemoconcentration may occur; At a laparocentesis find bile, as a rule, infected. The level of bilirubin in the serum increases, and later the activity of alkaline phosphatase increases. Holescintigraphy or cholangiography reveals the outflow of bile. Endoscopic or percutaneous drainage of the biliary tract improves the prognosis.

Treatment of bile peritonitis

It is obligatory to perform substitution infusion therapy; with paralytic intestinal obstruction, intubation may be required. To prevent secondary infection, antibiotics are prescribed.

When the gallbladder ruptured, cholecystectomy is indicated. When leavening bile from the common bile duct, you can perform endoscopic stenting (with or without papillosphincterotomy) or nasobiliary drainage. If the outflow of bile does not stop within 7-10 days, laparotomy may be required.