Biliary peritonitis
Introduction
Introduction to biliary peritonitis Biliary peritonitis (biliary peritonitis) is a peritoneal inflammation caused by leakage of bile from the biliary system into the abdominal cavity. Only bile-like fluid in the abdominal cavity and no peritonitis sign is simple biliary ascites. Bile peritonitis is usually caused by the infiltration of sterile bile into the abdominal cavity, the stimulation of bile salts and its chemical toxicity. Secondary bacterial peritonitis can occur if the bile is contaminated or if the original disease is infected. The most commonly infected bacteria are Escherichia coli, Streptococcus, Enterococcus, Klebsiella pneumoniae and Bacteroides fragilis, and the bacterial content is often >105/ml. basic knowledge The proportion of illness: 0.001%-0.002%, more common in the traumatic gallbladder rupture or perforation Susceptible people: no specific people Mode of infection: non-infectious Complications: intestinal obstruction shock
Cause
Causes of biliary peritonitis
Causes
1. Biliary peritonitis is caused by various causes of bile direct infiltration or extravasation into the peritoneal cavity causing acute or chronic secondary peritonitis. The causes are as follows:
Gallbladder perforation (30%):
Most commonly seen in:
1 acute cholecystitis: the cause of biliary peritonitis stone, no stone and typhoid.
2 trauma: including penetrating and blunt.
3 tumor: gallbladder cancer, stomach or transverse colon cancer invasion.
4 penetrating peptic ulcer.
5Crohn disease.
6 idiopathic.
7 thrombotic thrombocytopenic purpura and the like.
Liver/biliary system damage (20%):
Common in:
1 liver biopsy.
2 percutaneous hepatic cholangiography.
3 postoperative complications.
4T tube displacement.
5 Trauma: including penetrating and blunt.
Spontaneous biliary gallbladder perforation (20%):
Seen at:
1 Children are developmental.
2 adults: 75% have common bile duct stones, biliary cyst rupture and biliary tract infection, biliary diverticulum.
Idiopathic (10%):
Seen at:
1 gallbladder perforation is the most common cause of biliary peritonitis, about 10% of patients with acute cholecystitis will progress to gallbladder perforation, gallbladder perforation can be divided into 3 types, type I: free perforation, accounting for 30%, most often in the gallbladder Bottom, due to local lack of protective adhesions, bile flow into the peritoneal cavity, forming biliary diffuse peritonitis, type II: localized perforation, accounting for 50%, bile overflow to adjacent organs (such as liver, stomach, twelve fingers Intestinal, colon or small intestine), large omentum wrapping or adhesion, leading to localized abscess, type III: chronic perforation, accounting for 20%, how slowly it progresses to gallbladder intestinal fistula.
2 biliary tract surgery or abdominal trauma is also a common cause of biliary peritonitis. In surgery, it may be caused by direct injury of the gallbladder or bile duct, or due to postoperative gallbladder, detachment of the stump of the bile duct surgery, anastomotic leakage, or drainage tube displacement injury. Etc. caused by biliary peritonitis, the incidence of bile duct injury increased after laparoscopic cholecystectomy, the incidence of up to 0.5% in a large case study, and only 0.2% of open cholecystectomy.
3 biliary peritonitis is a rare biopsy, percutaneous hepatic cholangiography, percutaneous hepatic biliary drainage and other rare complications, mainly through the liver puncture injury or stab the gallbladder or bile duct system caused by perforation, penetration, Especially seen in patients with bile duct dilatation due to mechanical obstruction in the liver and external bile duct system.
2. Spontaneous perforation of the biliary tract is a very rare cause of adult biliary peritonitis, and its pathogenesis may be related to the following factors.
(1) The pressure in the bile duct is increased due to obstruction of the Oddi sphincter or stone, narrowing of the duodenal papilla.
(2) Partial pressure necrosis of the wall due to obstruction of the hepatic duct or common bile duct by stones.
(3) Infection of the wall caused by bile duct inflammation.
(4) biliary system diverticulum or cyst.
(5) Partial necrosis of the bile duct caused by thrombosis of the blood vessels in the common hepatic duct or common bile duct wall.
(6) Liver retraction due to cirrhosis.
(7) The pancreatic juice is recirculated through the common channel opening of the pancreatic duct and the bile duct, and the bile duct tissue is digested and eroded.
(8) Anatomical structural features, such as insufficient supply of arterial blood at the entrance of the common bile duct.
Prevention
Bile peritonitis prevention
Early and appropriate treatment of intra-abdominal inflammatory diseases that may cause peritonitis is a fundamental measure to prevent peritonitis. Any abdominal surgery, including abdominal puncture, should be performed strictly.
Complication
Complications of biliary peritonitis Complications, intestinal obstruction, shock
Clinically, there are often serious complications such as intestinal obstruction, abdominal mass, fever, oliguria and shock.
Symptom
Biliary peritoneal inflammation symptoms Common symptoms Abdominal pain Peritoneal irritation of the liver capsule hematoma rupture oliguric peritonitis bowel movement dullness
The clinical signs and symptoms of biliary peritonitis depend on whether the extravasated bile is confined or diffused in the peritoneal cavity, whether it is contaminated by bacteria, and the symptoms change greatly, which may manifest mild abdominal pain, and may also show obvious severe abdominal pain, intestines. Obstruction, abdominal mass, fever, oliguria and shock and other serious symptoms; can be sudden onset, but also slowly onset, abdominal pain and peritoneal irritation can be stimulated by the peritoneum, its exudate rapidly accumulates and dilute and neutralize Bile salts and their chemical toxicity, and temporarily relieve symptoms and signs, especially in the treatment of infusion, due to the stimulation of bile salts, not only increase the peritoneal exudate, but also a large amount of plasma infiltration into the abdominal cavity, the abdomen can and mobile dullness, abdominal pain can change with the position, especially when changing from the supine position to the supine position, abdominal pain can be transferred from the right upper abdomen to the lower right abdomen, the bowel sounds may be weakened or disappeared.
Examine
Examination of biliary peritonitis
1. Patients often have elevated white blood cell counts, elevated levels of blood bilirubin and alkaline phosphatase, and sometimes blood concentration may occur.
2. Abdominal puncture This test has a diagnostic value for biliary peritonitis. A deep yellow liquid can be found in the peritoneal aspiration fluid. The bilirubin level is usually 102.6mol/L (6mg/dl), ascites bilirubin/serum. Bilirubin > 1.0.
3. In laparoscopic, surgical or autopsy, the signs of bile staining of the peritoneum are found to be a gold test for the diagnosis of biliary peritonitis. If 131I-tetraiodofluorescein is injected intravenously, the substance is found in ascites. Helps diagnose patients with active bile leakage.
4. In ERCP or intraoperative cholangiography, it is found that the contrast agent penetrates into the abdominal cavity, which helps to find the site of bile leakage or biliary perforation.
5. Abdominal X-ray examination is non-specific, which can be used to exclude abdominal pain caused by other causes. In addition, CT, ultrasound, MRI and other imaging examinations can help the differential diagnosis of abdominal mass.
Diagnosis
Diagnosis and diagnosis of biliary peritonitis
The above clinical manifestations are non-specific, but the possibility of biliary peritonitis should be highly suspected in combination with medical history. If the exuded bile is contaminated by bacteria, clinical signs of bacterial peritonitis may appear.
1. Clinical manifestations.
2. Laboratory and other auxiliary inspections.
