Abstract
Biliary peritonitis due to bile leakage from the gallbladder not associated with any perforation is very rare. An 89-year-old man was diagnosed to have generalized peritonitis and admitted to our hospital. Abdominal computed tomography revealed the presence of ascites around both the right lobe of the liver and the gallbladder, and a collapsed gallbladder. Ultrasound-guided peritoneal paracentesis indicated biliary ascites. The patient was diagnosed to have biliary peritonitis caused by perforation of the gallbladder, and an emergency laparotomy was performed. A large amount of biliary ascites was found in the right upper portion of the abdomen. Although the gallbladder wall was thinned out at the fundus, no perforation was detectable. No other lesions causing bile leakage were observed. A cholecystectomy and drainage around the gallbladder were performed. An oval mucosal defect, approximately 1.3 cm in size, was observed in the fundus of the gallbladder. Bacterial culture of the bile was negative. Histopathological examination revealed hemorrhage and necrosis throughout the remaining thickness of the wall. The biliary ascites did not recur after the surgery. Although the patient suffered from multiple organ failure postoperatively, he recovered gradually, and was discharged from the hospital on the 35th postoperative day. The cause of biliary peritonitis in this case was considered to be biliary leakage from the necrotic portion of the gallbladder wall. It was suspected that necrosis of the gallbladder was caused by circulatory failure of the bladder due to sclerosis of the arterioles, although no evidence of such lesions was found in this case.
