Spontaneous and postoperative bile peritonitis. Surgical technique

Background. Bile peritonitis has a diversified aetiology that can present in clinical pictures of variable gravity depending on whether the bile is uncontaminated or activated by other secretions (intestinal, pancreatic) or actually infected. The consequent treatment is therefore eclectic. In our opinion, however, the therapeutic strategy proves effective if modulated on the basis of certain priority elements that should be carefully considered. The type of treatment adopted in relation to immediate and long-term results has been evaluated. The investigation was carried out retrospectively on the series of bile peritonitis treated at the Surgical Clinic of the University of Modena from 1980 to 1998. 45 cases of bile peritonitis are reported of which: 32 postoperative, 2 post-traumatic, 2 following transparietohepatic injection, 7 during acute necrotic cholecystitis, 2 following spontaneous perforation of the biliary tree. As regards the type of treatment, in 13 cases (well-drained postoperative forms) a conservative solution was adopted; in another 13 cases (9 septic and 4 with mixed bile supply) surgery was resorted to again, in the remainder transparietohepatic drainage was carried out in association almost always with the application of a transpapillary endoprosthesis. Results. Morbility was 26.6% (12 cases); 4 patients (8.8%) were reoperated for late complications with mortality of 50%. Total mortality was 20% (9 patients). Conclusions. Treatment of bile peritonitis may be eclectic but the complex forms benefit from early surgical or parasurgical treatment for a definitive resolution of this feared complication.