CLINICAL PROFILE AND MANAGEMENT OF PATIENTS PRESENTING WITH BILIARY PERITONITIS AFTER ENDOSCOPIC AND SURGICAL INTERVENTION.

Abstract

BACKGROUND:   There is growing concern among surgeons about the hazards of extravasation of bile, an infrequent complication that may occur following the endoscopic or surgical intervention of liver or biliary passage. The incidence of biliary leaks in the era of laparoscopic approaches is significantly higher than for open cholecystectomy.So in this era of laparoscopic surgeries, it was worthwhile to study this entity in our patients as it is associated with significant morbidity and even mortality, particularly if it is not identified and treated at an early stage.

OBJECTIVES:  To study the clinical profile of patients with biliary peritonitis after a surgical or endoscopic procedure.

                        To study the outcome of management of these patients.

STUDY DESIGN:  Retrospective cum Prospective observational study.

METHODS:: This study conducted at SKIMS, Srinagar was a prospective cum retrospective observational study. After approval of study protocol by the ethical committee of the institute, all records of patients were thoroughly scrutinized including records of intervention as per performa . The factors relating to outcome including the type of primary procedure, the type and severity of the injury, the procedure in case needed, and morbidity and mortality were noted. 

RESULTS:  A total of 53 patients were included in the study group. The mean age was observed as 39.4  +_4.67.The percentage of female patients was more than male. The average amount of bile leak was observed as 14.4+_65.7 ml. The most common intervention received was pigtail drainage followed by ERCP and stenting. A minority of patients underwent E\L with Roux En Y hepaticojejunostomy. The most common complication post-intervention was sepsis followed by pancreatitis & cholangitis. 96 % of cases recovered successfully and 4 % died due to serious complications like sepsis, pancreatitis, and cholangitis.

CONCLUSION: A postoperative biliary leak can be very dangerous for patients and can present a myriad of problems like biliary peritonitis, cholangitis, and sepsis if not treated and managed properly on time. From the observations, it was concluded that most patients who had postoperative biliary peritonitis had undergone lap cholecystectomy. Among the study group,96% were successfully treated and managed by surgical or nonsurgical interventions, however, 4% died due to serious complications. The successful management of biliary peritonitis requires close coordination of multiple departments like radiology, surgery, and gastroenterology.