Ascitic Fluid Bilirubin Concentration as a Key to Choleperitoneum

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Abstract
Total bilirubin concentration was measured in the ascitic fluid and serum of 65 patients with various types of ascites to determine the normal range of these parameters. The mean (±SD) ascitic fluid bilirubin was 0.7 ± 0.8 mg/dl, and the mean ascitic fluid/serum bilirubin ratio was 0.38 ± 0.44. Subsequently, I recognized choleperitoneum in a patient with bile-stained ascites preoperatively, because the ascitic fluid bilirubin was 18.5 mg/dl and the ratio was 7.1. Laparotomy documented a ruptured gallbladder. An ascitic fluid bilirubin concentration greater than 6 mg/dl with an ascitic fluid/serum bilirubin ratio greater than 1.0 appears to be characteristic of choleperitoneum.

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