Bilious peritonitis

Description:

The peritoneum inflammation developing at a perforation of a gall bladder or extrahepatic bilious channels.

Reasons of bilious peritonitis:

After a cholecystectomia bile can filter from a bed of a bubble or untightly tied up vesical channel. Increase in pressure in bilious ways, for example in connection with an unextracted stone of the general bilious channel, strengthens the expiration of bile which accumulation around bilious ways promotes development of their stricture.
After transplantation of a liver dribble of bile from area of an anastomosis of bilious channels is possible.
The empyema or gangrene of a gall bladder can be complicated by its gap with formation of abscess. Osumkovyvaniya of the streamed contents the commissures formed earlier promote.
Stupid or gunshot wounds of bilious ways and, seldom, a puncture of a gall bladder or an expanded intra hepatic channel belong to the traumatic reasons of bilious peritonitis at a puncture biopsy of a liver, and also at ChChHG at patients with the expressed cholestasia. Dribble of bile is sometimes observed after an operational biopsy of a liver.
Spontaneous bilious peritonitis can develop at heavy long mechanical jaundice without visible damages of bilious ways. This phenomenon is explained with a rupture of small intra hepatic channels.
Perforation of the general bilious channel meets very seldom and perforation of a gall bladder is caused by the same reasons, as: increase in pressure in bilious ways, a wall erosion a stone and its necrosis as a result of thrombosis of vessels.
Sometimes jaundice of newborns is caused by spontaneous perforation of extrahepatic bilious channels which is most often localized in the place of merge vesical and the general hepatic channels.

Symptoms of bilious peritonitis:

Expressiveness of symptoms depends on extent of distribution of bile on an abdominal cavity and its contamination. Hit of bile in a free abdominal cavity leads to heavy shock. Bilious salts chemically irritate a peritoneum that causes exudation of large volumes of plasma in ascitic liquid. Outpouring of bile is followed by the strongest diffuse abdominal pains. At survey of the patient it is not mobile, integuments pale, the low arterial pressure, persistent tachycardia, doskoobrazny rigidity and diffusion morbidity at a stomach palpation are noted. Often intestines paresis therefore at patients with inexplicable intestinal impassability it is always necessary to exclude bilious peritonitis develops. In several hours consecutive infection joins that is shown by fervescence against the background of the remaining abdominal pains and its morbidity.
Results of laboratory researches are not indicative. Haemo concentration can be observed; at a laparocentesis find bile, as a rule, infected. Bilirubin level in serum increases, activity of an alkaline phosphatase increases later. Holestsintigrafiya or a holangiografiya reveal the bile expiration. Endoscopic or transdermal drainage of bilious ways improves the forecast.

Treatment of bilious peritonitis:

Performing replacement infusional therapy is obligatory; at paralytic intestinal impassability the intestines intubation can be required. For prevention of consecutive infection appoint antibiotics.
At a rupture of a gall bladder the cholecystectomia is shown. At dribble of bile it is possible to execute endoscopic stenting from the general bilious channel (with a papillosfinkterotomiya or without it) or nazobiliarny drainage. If the expiration of bile does not stop during 7-10 days, the laparotomy can be required.