Free escape of bile into the peritoneal cavity in adults generally is considered to be an acute and serious situation with a high mortality rate. In a review of more than 7,000 cases of perforation of the gallbladder, collected from six authors, Eliason and McLaughlin1 reported a mortality rate in adults of 10% to 85%. In a series reported by Butler and Harkins,2 all patients with untreated acute perforation of the gallbladder died. Mentzer3 stated that infected bile spreading diffusely throughout the peritoneal cavity produces an acute peritonitis that would be fatal unless treated surgically. Morse and associates4 wrote that the mortality rate in all untreated cases of acute perforation of the gallbladder is 100%.
Our interest in this subject was stimulated by experience with four adults during the past eight years who, clinically, did not present with the usual acute picture associated with peritoneal contamination