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Bile peritonitis in acute cholecystitis.

R Andersson1, K G Tranberg, S Bengmark

  • 1Department of Surgery, Lund University, Sweden.

HPB Surgery : a World Journal of Hepatic, Pancreatic and Biliary Surgery
|March 1, 1990
PubMed
Summary

Early surgery for acute cholecystitis significantly reduces mortality from bile peritonitis. Delaying surgery increases risks, especially in elderly patients or those with gallbladder perforation, highlighting the importance of timely intervention.

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Area of Science:

  • Gastroenterology
  • Surgical Outcomes
  • Infectious Disease

Background:

  • Acute cholecystitis is a common surgical emergency.
  • Bile peritonitis can occur in acute cholecystitis, posing significant risks.
  • Management strategies, particularly surgical timing, are critical.

Purpose of the Study:

  • To evaluate the impact of surgical timing on mortality in patients with bile peritonitis secondary to acute cholecystitis.
  • To identify prognostic factors influencing outcomes in this patient group.

Main Methods:

  • Retrospective review of 5848 patients treated for acute cholecystitis over 18 years (1969-1986).
  • Comparison of outcomes between two hospitals with differing surgical timing protocols (early vs. delayed surgery).
  • Analysis of bile cultures, perforation status, patient demographics, and mortality rates.

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Main Results:

  • 1.8% (104/5848) of patients had bile within the abdominal cavity; 71 had gallbladder perforation.
  • Bile was infected in 82% of cultures, predominantly with Escherichia coli.
  • Overall mortality was 7.7%. Mortality was significantly higher in the delayed surgery group (20%) compared to the early surgery group (5%).
  • Infectious complications leading to multiple organ failure were the primary cause of death.
  • Surgical delay was the most significant negative prognostic factor; elderly patients and those with perforation had worse outcomes.

Conclusions:

  • Early surgical intervention in acute cholecystitis is crucial for reducing mortality associated with bile peritonitis.
  • Prompt management minimizes risks of infectious complications and subsequent organ failure.
  • Timely surgery improves patient prognosis, irrespective of age or perforation status.