Biliary peritonitis may occur as a complication of biliary surgery, e.g. spillage of infected gall bladder contents during a laparoscopic cholecystectomy. Detection of the leak may be through evidence of bile emerging from the drain within the first 24 hours postoperatively.
If the bile is not infected then a chemical peritonitis develops. Infected bile may cause generalised peritonitis and carries a high risk of mortality. Alternatively, infected bile may produce a subphrenic abscess.
Bile has a detergent action and therefore may leak through suture lines. This necessitates the placement of a drain for two to five days.
Small leakages of bile generally settle spontaneously. If generalised toxicity develops then this may necessitate re-exploration under IV antibiotic cover.
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