Isolated intraperitoneal accumulation of bile after surgical or diagnostic procedures

In 1969-1986 intraperitoneal accumulation of bile occurred in 21 patients after elective cholecystectomy or choledochotomy (n = 16) or percutaneous fine-needle cholangiography or biopsy (n = 5). The cause was established in all but one of the surgical cases, viz. T-tube removal (8), injury to the common bile duct (3), unrecognized aberrant bile duct (3) and leakage from liver biopsy (1). The intraperitoneal accumulation of bile led to laparotomy in 19 cases, when the median amount of bile found was 500 ml (range 100-3,500 ml). Mortality was nil, and only few and relatively minor complications could be attributed to the accumulation of bile--pleural effusion (2 cases), wound rupture (1), lower-limb venous thrombosis (1) and strictured hepatojejunostomy (1). There were no infectious complications. It is concluded that intraperitoneal accumulation of bile alone after elective surgical or invasive diagnostic procedures does not usually lead to severe complications, and that it seems distinctly less noxious than the bile peritonitis associated with acute cholecystitis.