[Postoperative biliary peritonitis--diagnosis and treatment difficulties]. / Peritonitele biliare postoperatorii--dificultati de diagnostic si tratament.

ABSTRACT

AIM: To point out the severity of the postoperative biliary peritonitis (PBP) and to established the most proper ways of diagnosis and treatment. MATERIAL AND METHODS: 14 PBP (6 males and 8 females, age between 42 and 76 years) admitted in the last 14 years were analyzed. The PBP occurred after biliary surgery in 13 cases and after gastro-duodenal surgery in 1 case. The delay between the first operation and the establishing of the diagnosis and reoperation varied between 24 hours and more than 3 days. All the patients were operated on; the operation had to fulfill 2 main objectives: the treatment of the peritonitis and to solve the biliary lesions. RESULTS: 6 patients had a fair evolution. We registered 8 complications with a morbidity rate of 57,14% and 2 deaths with a mortality rate of 14,3%. CONCLUSIONS: 1. Postoperative biliary peritonitis is one of the most severe complications of the biliary and gastro-duodenal surgery, due to preoperative unrecognized biliary lesions or occurring as postoperative accidents or complications. 2. The clinical picture, deeply modified by the complex postoperative treatment makes the early diagnosis very difficult and leads to a delay of the re-operation. 3. The treatment is exclusively a surgical one, with two main objectives: the biliary lesion repair and the treatment of the peritonitis. 4. The postoperative biliary peritonitis are charged by a high postoperative morbidity and mortality rate, the delay of the diagnosis and the time of reoperation being the main risk factor.