Generalized biliary peritonitis is a serious intra-abdominal emergency. In this situation, recognition of the pathology and its treatment is straightforward and is usually associated with a good outcome. There are a few unusual causes of biliary peritonitis, of which rupture of the biliary tree is one.Liver abscess with biliary communication poses management problem if percutaneous drainage is performed. We describe a rare case of biliary peritonitis in amoebic liver abscess due to rupture of an intra hepatic biliary radical after insertion of pigtail catheterisation. Prolonged high‑output bile after percutaneous drainage of liver abscess resulted biliary peritonitis and after surgical drainage also suspicion of communication of abscess with intrahepatic bile ducts (biliary fistula). Unusual causes of peritonitis do interrupt our daily routine emergency surgical experience. Rapid recognition of the presence of peritonitis, adequate resuscitation, recognition of operative findings, establishment of biliary anatomy, and performance of a meticulous surgical procedure resulted in a good outcome.
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