An association between leakage of contrast seen on T-tube cholangiogram and subsequent biliary peritonitis.

Abstract

Intraperitoneal leakage of bile can occur after routine cholecystectomy, following removal of the T-tube and following invasive diagnostic procedures, such as percutaneous transhepatic cholangiography and liver biopsy (Corbett et al, 1986; Lygidakis, 1986; Anderson et al, 1988). Spontaneous rupture of the common bile duct causing biliary peritonitis has been described (Kyzer et al, 1986). Bile is a cause of chemical peritonitis. Bacterial contamination of bile leads quite frequently to virulent septic peritonitis (McLaughlin, 1942; Schwartz, 1979). In a recent prospective study of the complications of T-tube drainage after choledochotomy and common bile duct drainage, three cases of biliary peritonitis occurred after removal of latex-rubber tubes in 36 patients (Gillett et al, 1985). PVC tubes, introduced in the 1960s, were known to cause an increased incidence of bile peritonitis (Anderson et al, 1988) after their removal, but it is now standard practice to use latex-rubber tubes.