Spontaneous biliary peritonitis in acalculous cholecystitis: Fact or misdiagnosis?

It is often speculated that an inflamed gallbladder weeps bile to produce b ile peritonitis. This may be so, but more likely the problem is a peritonea l effusion in a jaundiced patient which thus resembles bile. So-called "spo ntaneous or idiopathic biliary peritonitis" in acute acalculous cholecystit is without a proven cause is a further example of this very rare condition. Spontaneous perforations of the extrahepatic biliary ductal system associa ted with acalculous cholecystitis are uncommon albeit reported in adults. M ost patients present with an acute abdomen and are operated upon urgently w ithout diagnostic iter. A recent experience with such a case prompted a tho rough review of 27 similar cases previously reported.