Abstract
An 85-year-old woman with right hypo-chondralgia was admitted to our hospital for a close examination. Samples obtained during abdominal paracentesis showed bile-like ascites. Emergent laparoscopy was performed to test for duodenal or gallbladder perforation. No signs of inflammation or apparent perforation were found in the gallbladder; however, there was bile leakage from the gallbladder fundus. The patient, who was diagnosed with biliary peritonitis due to transudation of bile from the gallbladder, underwent laparoscopic cholecystectomy. Upon identifying a thrombus formed in the branch of a subserosal vein, we hypothesized that ischemia may have also contributed to the pathogenesis of the peritonitis. In similar cases, prognosis using a laparoscopic approach is favorable if peritonitis is due to non-infected bile. Although leakage of bile from the gallbladder is difficult to diagnose, we recommend it be considered in cases of acute abdomen, and appropriate operative procedures discussed.
