PERITONITIS DUE TO BILE AND TO LIVER AUTOLYSIS

Abstract

Bile peritonitis is a clinical entity due to the action of escaped bile on the peritoneal surfaces that is probably more common than has been realized. Eliason and McLaughlin1report that perforation of the gallbladder occurs in from 1 to 3 per cent of all cases of biliary disease. These figures were based on a study of more than 7,000 cases of gallbladder disease. It has also been recognized2that bile peritonitis may occur in the absence of demonstrable perforation of the biliary system. Once the importance of this hitherto rarely recognized condition was demonstrated, numerous experimental studies on the mechanism of death in bile peritonitis were made. These observations include the work of Horrall and others3and center chiefly around the postulates that toxic action and anaerobic bacterial invasion are the chief two lethal factors in bile peritonitis. From other data4similarly obtained by experiment,