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Bile Peritonitis: Causes, Symptoms, Treatment, Prognosis, Diagnosis

Bile peritonitis; also known as Biliary peritonitis is the peritonitis caused due to the presence of bile in the peritoneum or choleperitoneum. This condition may occur due to various causes. Sometimes Bile peritonitis also occurs in patients after the open operations on the Biliary tract or may also be caused after the needle biopsy of the liver. This condition of bile peritonitis may be serious if the patient has extensive bile peritonitis and requires an immediate surgery involving the drainage of the abdomen and repair of any other underlying pathological cause. In this article we will know about the causes, symptoms, treatment and prognosis of Bile Peritonitis or Biliary Peritonitis.

 Bile Peritonitis: Causes, Symptoms, Treatment, Prognosis, Diagnosis

Overview on Bile Peritonitis:

Bile peritonitis is a type of inflammation of the peritoneum which is caused due to the escape of bile in to the free peritoneal cavity. Perforation of gall bladder, biliary trauma (thoracoabdominal trauma or Iatrogenic trauma), and extra-hepatic bile ducts or peptic ulcers’ spontaneous perforation may cause the leakage of bile in to the peritoneal cavity and generate the symptoms in Bile Peritonitis.

There are various conditions which may cause perforations in gallbladder (where the clear, yellow fluid produced by liver known as Bile is stored) or the common bile duct carrying the bile in to the small intestine whenever essential for digestion. Mostly such perforations are caused during per-cutaneous needle biopsy of the liver and also rarely erosion from biliary calculi may also cause the perforation leading to leakage of bile from the gall bladder or the common bile duct. There are serious conditions in Bile peritonitis where it may be fatal unless operation is carried out to repair bile peritonitis.

Symptoms of Bile Peritonitis:

Let us look at the symptoms of Bile peritonitis in this current section of our article. Before we go in to the symptoms; let us inform that symptoms for infectious bile peritonitis are usually acute; while the symptoms for non-infectious bile peritonitis are generally long-term. Some of the symptoms include:

Symptoms of Bile Peritonitis

  • Abdominal pain is the most common symptom.
  • Loss of appetite may be experienced
  • Energy loss is a common symptom
  • Vomiting may be a symptom of bile peritonitis
  • Loss of weight can be experienced
  • Diarrhea can be a symptom in bile peritonitis.
  • Skin turns yellow and yellowish white eyes seen as a symptom of Bile Peritonitis.
  • Swollen abdomen; comparatively larger in size than normal
  • In case of an infectious bile peritonitis, there can be symptoms of fever in the patient
  • The patient may collapse if there is infectious bile peritonitis.

Causes of Bile Peritonitis:

As mentioned earlier that Bile peritonitis is usually caused by inflammation of the gallbladder or the common bile duct which may be due to perforations or ruptures caused during percutaneous needle biopsy. Apart from this, inflammation in gallbladder leading to Bile Peritonitis may also be due to infection or a blockage of the gallbladder ducts because of the diseased conditions like gallstones, cancer, stenosis, pancreatitis etc.

Diagnosis for Bile Peritonitis:

Usually the peritoneum in normal condition appears to be greying and glistening. However, in case of the onset of peritonitis; the peritoneum gets dull within 2-4 hours. There may be scarce serous or light turbid fluid in the peritoneum in case of peritonitis and may later on the exudates get creamy. Symptoms shown or experienced in the condition of Bile peritonitis usually forms the basis of its diagnosis. Following are some of the diagnosis procedures used to detect peritonitis.

  • Blood sample test to determine white blood count
  • Abdominal X-rays
  • CT or CAT scanning may be done so as to know the cause of abdominal pain.
  • Whole abdomen ultrasound may also be performed if necessary
  • Laparoscopy or Peritoneal lavage may also be performed in some cases.

Treatments for Bile Peritonitis:

It is true that treatments for peritonitis depend on the source or underlying cause of the peritonitis. However in serious cases, an emergency laparotomy is usually performed where any damaged, ruptured or perforated organ is repaired.

Apart from this, Bile peritonitis is also treated by giving antibiotics through a needle in the veins along with the essential fluids so as to prevent dehydration. Antibiotics may also be directly infused in to the peritoneum. Cefoxitine, Cephalosporin, Ampicilin, Peperacilin etc are some of the antibiotics used.

Prognosis for Bile Peritonitis:

Untreated bile peritonitis has a poor prognosis and often leads to the patients’ death. However, with treatment the prognosis may vary based on the symptoms, level and conditions in the individual suffering from the bile peritonitis.


Because the diseases peritonitis accompanies are usually not under the voluntary control of an individual. So, there is usually no way to prevent peritonitis. However, being a bit careful while performing open operations of bile ducts can help prevent the perforations in the bile ducts, which may lead to bile peritonitis or a leakage of bile in to the peritoneal cavity. Prompt treatments in severe cases of Bile peritonitis can help one prevent any complications.

With the onset of any symptom like abdominal pain, serious diarrhea, vomiting, fever, etc; it is essential to visit a doctor and undergo the appropriate diagnosis and follow up treatments as prescribed by the medical professional so as to get rid of any danger in Bile peritonitis.


  1. Rencuzogullari, A., Sert, I., Akbulut, S., Yilmaz, S., & Basbug, M. (2016). Biliary peritonitis due to direct needle liver biopsy. Case Reports in Surgery, 2016, 3194136. doi:10.1155/2016/3194136
  2. Crumbley, A. J., & Bailey, H. R. (2021, June 25). Peritonitis. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK459140/
  3. Kalakoti, P., Kumar, N., Kalakoti, P., & Beniwal, M. (2021, July 20). Biliary Peritonitis. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK513368/
  4. Al-Temimi, M. H., Chandrasekaran, B., & Millas, S. G. (2019, July 18). Biliary Peritonitis. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482470/
Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:July 31, 2023

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