Biloma a pseudocyst mimic

Abstract

Bilioma is defined as an encapsulated collection of bile inside or outside of the biliary tree within the abdominal cavity. We report a case of a 56 years old male presented with complaints of abdominal distention and abdominal pain for 1 month whom on initial imaging, a diagnosis of pseudocyst of pancreas was suspected but on further imaging with MRCP, a biloma formation was found. Intervention involving Hepatobiliary tree is the most common etiology of a biloma formation. Biloma can also be caused by abdominal trauma and choledocholithiasis. In terms of treatment, small and uncomplicated cases need no intervention as spontaneous resolution is expected and in severe cases a combined approach using percutaneous drainage of biloma and endoscopic retrograde cholangiopancreatography (ERCP)-guided biliary stent placement across the site of the biliary leak or surgical hepaticojejunostomy or just image guided percutaneous drainage alone would be the treatment choice. Biloma should be included in the differential diagnosis of a large cystic lesion of the abdomen.