A CASE OF BILE PERITONITIS DUE TO BILE LEAKAGE CAUSED BY ACALCULOUS AND NONPERFORATIVE CHOLECYSTITIS

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  • 無石性非穿孔性胆嚢炎により生じた漏出性胆汁性腹膜炎の1例

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Abstract

We report a case of bile peritonitis due to bile leakage caused by acalculous and nonperforative cholecystitis.<br> A 75-year-old man was admitted to our hospital because of abdominal pain and vomiting. We doubted that he had acute cholecystitis by abdominal ultrasonography (US), computed tomography (CT) and abnormalities in the liver and pancreas functions. The day after admission he showed a defensive sign at the abdomen and ascitis by abdominal US and CT scan. Puncture-exudate of ascites revealed that he had bile peritonitis. So we conducted emergency laparotomy. We found bile retention in the abdominal cavity despite absence of abnormal findings in the liver, common bile duct and duodenum. There were localized thinning parts in the neck, body and corpus of the gallbladder, bile leakage from where was not identified macroscopically. However, we considered that bile leakage occurred from the parts, and performed cholecystectomy and abdominal drainage. Histopathologically, the gallbladder was in an acute phase of chronic cholecystitis. Erosion ulcer, and even autolysis on the mucusa were seen at the parts of the thinning walls of the gallbladder. We thought that the injury of the gallbladder wall might be caused by autolysis due to regurgitated pancreatic juice.

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