Perforation of the biliary tarct is a serious abdominal catastrophe with a high mortality rate. The presence of bile in the peritoneal cavity oftern results in pritonitis more severe and more rapidly fatal than peritonitis resulting from other causes.
The relative infrequency of the occurrence of perforation of the biliary tract, the delay in diagnosis and serious prognosis when treatment is delayed make it and important surgical problem.
The subject of perforation of the biliary tract, especially about the bile peritonitis, has been reviewed and a series of 45 cases of perforated biliary tract treated in the 6 year period, 1963, Jan to 1968, Aug, at ST Mary´s Hospital is presented. During this period, total number of biliary tract surgery was 301 cases. Incidence of bile preitonitis was 12%. There was no significant difference in ths sex incidence: 88% of the patients were 40 year or age or over. The diagnosis were diffidult and 35% of preoperative diagnosis were consistent with operative finding in bile peritonitis. Predominant cause of bile peritonitis was perforation of the gall bladder.
Excellent surgical results were obtained with thorough saline irrigation of peritoneal cavity, repair and drainage of leak site, in addition to fluid replacement therapy.
Four death occured in this series. Cause of the death were hypovolemia and dehydration, cachexia due to Carcinoma, endotoxin shock and cardiac failure.
Attention is called to the seriousness of this clinical entity. We wish to stress on early diagnosis and immediate surgical intervention inclulding thorough peritoneal irrigation of soiled peritoneal cavity with cholecystectomy or repair of leakage.
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