Cytological findings in a sample of peritoneal aspirate from a case of bile peritonitis

Abstract

Bile peritonitis (BP) is a rare and serious condition warranting urgent surgical intervention to prevent the high incidence of mortality. BP is ascribed to the leakage of bile into the peritoneal cavity usually due to a perforation of the gallbladder or common bile duct caused by stones or a trauma. The radiological studies are useful in suggesting the diagnosis. The cytological findings of BP have been reported rarely in the literature characterised by the presence of lakes of stringy bile material admixed with variable numbers of histiocytes, mesothelial cells, and some inflammatory cells. Recently, we have examined an aspirate sample of peritoneal fluid (PF) obtained under ultrasound guidance in a case of BP ascribed to the perforation of the gallbladder in a 19-yr-old female patient in which apart from occasional bile pigment-laden macrophages admixed with a few mesothelial cells and inflammatory cells, numerous crystalline structures of varying shapes, sizes, and colour with birefringence along with some microspheroliths were found. At operation, the abdominal cavity showed a large amount of bile and the gallbladder specimen showed two perforations and gangrenous cholecystitis with numerous yellow-brown somewhat friable stones. The foregoing findings in the aspirate appeared to be of interest because to the best of our knowledge, numerous crystalline structures along with the cytological features of BP have not been described in the English literature.

Unusual Case of Biliary Peritonitis in a Dog Secondary to a Gastric Perforation

“…In some instances, the fluid associated with bile peritonitis may also be reddish due to the large number of erythrocytes leaking from the altered permeability vascular system [ 22 ]. Cytologically, bile peritonitis effusions is characterized by greenish, gold, or black-brown pigments free in the background or within macrophages [ 25 ]. Sometimes it can be difficult to distinguish bile pigment from the pigment of red blood cell degradation products (hemosiderin) that appears as blue-green globular material; in this case, the evaluation of bilirubin concentration in the effusion may play a key role [ 26 ].…”