|
KMID : 0371319640060090507
|
|
Journal of the Korean Surgical Society
1964 Volume.6 No. 9 p.507 ~ p.514
|
|
|
Bile Peritonitis
|
|
柳運相/Yu, Woon Sang
金昌權/朴富熙/崔台馹/金春奎/Kim, Chang Kwon/Park, Bu Hi/Choi, Tae Il/Kim, Choon Kyu
|
|
|
Abstract
|
|
|
In this paper we present a study of the patients with bile peritonitis treated in the last 5 years at the Yon Sei Medical Center, together with a review of previous publications on this subject.
Bile peritonitis is an uncommon abdominal catastrophe. However, in spite of its rarity, it forms a subject of considerable interest because of the wide range of pathological processes, some but poorly understood, which give rise to this condition.
It is generally accepted that a perforation of the gall-bladder into the free peritoneal cavity will prove fatal unless surgically treated. Infection, bile peritonitis and shock singly or in combination, are responsible for the almost invariably fatal outcome. This is especially true since we have seen that practically all the cases of perforation of the gall bladder occur in patients with acute cholecystitis.
Clinical symptoms of bile peritonitis are not different mostly from other types of peritonitis, that is to say, difuse generalized abdominal pain, abdominal rigidity, rebound tenderness and other peritoneal irritation signs. This is the reason why preoperative correct diagnosis of bile peritonitis is difficult. In this study preoperative diagntsis was correct in 50% of patients.
Most of authors were usually correct in their diagnosis of bile peritonitis no more than 30% preoperatively. Sex incidence were 5 to 3 favor to male and age incidence were between 36 to 63 years old.
Table 1 shows the duration of the present illness. In more than half of our patients perforations occurred within 5 days of onset of symptoms. Most of patients had waited from one to 3 days after onset of illness tc come to the hospital.
3 out of 8 patients had a history of cholecystitis in the past prior to admission. 5 patients had no suggestions of cholecystitis(Table 2). Preoperative diagnosis was made as follows: bile peritonitis 4 cases, empyema of gall bladder 2 cases, rupture of hollow viscus 1 case, incarcerated inguinal hernea 1 case.
5 cases had a perforation of gall bladder and in the rest of cases we could not find any perforation in the gall bladder or other biliary tract. Aspirated amount of bile during the operatitis procedure were ranged from 300 ml. to ml. Operative treatment was cholecystectomy and choledochostomy if it is possible, but most of cases were so poor in general condition that only cholecystostomy and drainage was done in these cases. Operative mortality was only one case and casuse of death was most likely due to so called hepato renal syndrome.
A correct pre-operative diagnosis of a perforated gall bladder is quite unusual as shown by a review of the reported cases in literature. In those cases in which there is a widespread soiling of the peritoneum without localization of the lesion, diagnosis of perforated ulcer, ruptured appendix, and difuse peritonitis of undetermined origin have been frequently made.
Most of surgeons are in agreement with primary cholecystectomy if it is possible and by doing so operative results are good compare to non-resected cases.
Generally speaking, the possibility of gall-bladder perforation are more prone to occur in elder patients rather than in young adults.
|
|
|
KEYWORD
|
|
|
|
|
|
FullTexts / Linksout information
|
|
|
|
|
Listed journal information
|
|
  
|
|