Bile Peritonitis in Acute Cholecystitis

Roland Andersson,Karl-Göran Tranberg,Stig Bengmark

doi:10.1155/1990/23517

Abstract

A review of all patients treated for acute cholecystitis (n=5848) during an 18-year period (1969–1986) at two hospitals (one practising early surgery in patients with acute cholecystitis and the other not) disclosed that 104 (1.8%) had bile within the abdominal cavity at surgery; 71 with a visible perforation of the gallbladder and 33 without. The bile was infected in 82% of performed cultures (most commonly with Escherichia coli). Mortality was 7.7% (8/104 patients), being 20% (4/20)in the hospital practising delayed surgery and 5% (4/84) in the hospital practising early surgery (p<0.10). Infectious complications were responsible for the deaths by leading to multiple organ failure with pulmonary or renal insufficiency or gastro-intestinal bleeding. The timing of surgery was the only factor that had prognostic significance, i.e. the longer the hospital delay before surgery the higher the mortality, although elderly patients or patients with perforation tended to have a worse prognosis. In conclusion, the results of this study indicated that early surgery is important in patients with acute cholecystitis as a means of lowering mortality in bile peritonitis in this condition.

Highlights

The first report on perforation of the gallbladder was published in 18441 and has been followed by a number of reports documenting its severity, especially when associated with acute cholecystitis
This study reviews our experience of bile peritonitis in acute cholecystitis and aims at defining factors of prognostic importance
During the 18-year period 1969 to 1986, 5848 patients were treated with a diagnosis of acute cholecystitis at the Departments of Surgery, Lund University (n 4940) and Ystad General Hospital (n 908)

Summary

Introduction

The first report on perforation of the gallbladder was published in 18441 and has been followed by a number of reports documenting its severity, especially when associated with acute cholecystitis. This study reviews our experience of bile peritonitis in acute cholecystitis and aims at defining factors of prognostic importance. During the 18-year period 1969 to 1986, 5848 patients were treated with a diagnosis of acute cholecystitis at the Departments of Surgery, Lund University (n 4940) and Ystad General Hospital (n 908). This retrospective study was focussed on the 104 patients (1.8% of all patients) that had bile within the abdomen at operation; 71 (68%) patients had a perforated gallbladder, whereas 33 (32%) patients did not have an obvious perforation. In Lund bile peritonitis was found in 84 patients (1.7% of all patients) and in Ystad in 20 patients (2.2% of all patients)

Methods

Results

Conclusion