Biliary peritonitis

Biliary peritonitis

Biliary peritonitis is mostly seen after cholecystectomy and arises from slippage of a clip o ff the cystic duct, drainage of bile from an accessory cystic duct or perforation of the common bile or hepatic duct (see Chapter 71 ). It can also arise after hepatectomy or duodenal surgery , although this is unusual if a drain has been placed at the time of surgery . Investigation follows the principles and steps described in Peritonitis . The natural course of biliary peritonism varies depending on the volume of contamination. In severe con - tamination the patient will be e xtremely unwell and urgent intervention is required. Localised collections can be treated by percutaneous inser - tion of a drain followed by endoscopic retrograde pancreato - graphy (ERCP) to identify the source of bile leak. ERCP enables placement of a stent across the source of the leak. Di ff use or high-volume contamination, or the presence of multiple sepa - rate locules, normally mandates surgical explora tion with the aim being lavage and drainage.