Biliary leakage

Vagus shock might also be caused by postbioptic biliary leakage with acute irritation of the serosa. H. Thaler observed this event 19 times in 7,500 biopsies we have witnessed it just once with 4,124 biopsied patients. This would suggest that bile-related acute irritation of the serosa is only in rare cases likely to be the cause of a peritoneal shock. 

Aftercare for each point of puncture should be continued until the bleeding has definitively stopped and delayed biliary leakage can be ruled out. Upon termination of laparoscopy, the site of puncture and the abdominal cavity as well as the point of exit of the Veres cannula must be checked for signs of bleeding. The Veres cannula should be withdrawn under observation. 

Seewald S, Groth S, Sriram PV, et al. Endoscopic treatment of biliary leakage with n-butyl-2 cyanoacrylate. Gastrointest Endosc. 2002 56 916-919. 

The liver is involved in a variety of both synthetic and catabolic functions, including metabolism of amino acids, lipids, carbohydrates, protein synthesis and detoxification [ 1 ]. These metabolic functions are performed mainly by hepatocytes, although the liver is made of three major cell types (hepatocytes, biliary epithelial cells and Kupffer cells). Exerting many different metabolic functions, the liver contains several different and specific enzymes, leakage of which into the bloodstream occurs in hepatic diseases. 

Biliary tract diseases, such as cholecystitis, cause up to fourfold elevations of the serum AMY activity as a result of either primary or secondary pancreatic involvement. Various intraabdominal events can lead to a significant increase in serum AMY activities up to a fourfold elevation and sometimes beyond. Such increases may be due to leakage of the P-AMY from the intestine into the peritoneal cavity and then into the circulation. Peritonitis and acute appendicitis have been reported to produce a slight elevation (up to twofold and threefold) of serum AMY activity. Serum AMY is normal in most patients with ectopic pregnancies, but increases have been seen in advanced cases of ruptured ectopic pregnancy. 

Bile contains a large number of diverse proteins, some resulting from leakage of hepatocellular protein and others derived from plasma (A9, R6). In certain cases, the liver may secrete specific proteins into bile to bind and thus prevent the reabsorption of potential toxins and thus facilitate fecal excretion of these substances (S3). As an example, copper is excreted principally by the biliary route, bound to a carrier protein that prevents intestinal absorption of the biliary copper (G6). The GST can bind a wide range of substances and we have studied the GST content of human bile using material obtained from intact gallbladders following removal at cholecystectomy. 

Contaminated sites surgeries involving open, fresh, accidental trauma, or surgeries with major aseptic technique violation or much leakage of contents from the intestinal tract. Such sites include infected biliary tracts... 

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