Biloma: A Rare Manifestation of Spontaneous Bile Leak.

Muhammad N Yousaf,Charmian Sittambalam,Fizah Chaudhary,Rowena G D'Souza,Hamid Ehsan

doi:10.7759/cureus.8116

Muhammad N Yousaf, Charmian Sittambalam + Show 3 more

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https://doi.org/10.7759/cureus.8116

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Abstract

A biloma is an intrahepatic or extrahepatic encapsulated collection of bile outside of the biliary tree and within the abdominal cavity. Hepatobiliary interventions and laparoscopic cholecystectomy are the most common etiologies of biloma followed by abdominal trauma, choledocholithiasis, and biliary dilation secondary to biliary stricture. We report a case of a 91-year-old female who presented to the emergency room with an acute onset of epigastric and right upper quadrant sharp pain for one day that radiated to the back, and was associated with two to three episodes of vomiting. Initial abdominal imaging including CT scan, ultrasound and magnetic resonance cholangiopancreatography (MRCP) of the abdomen and pelvis revealed a distended gallbladder with wall thickening, but without evidence of pancreatitis or gallstones. Hepatobiliary iminodiacetic acid (HIDA) scan findings were consistent with extrahepatic biliary leakage into the peritoneum. A cholangiogram demonstrated a perihepatic biloma. A combined approach using fluoroscopic-guided biloma drainage and endoscopic retrograde cholangiopancreatography (ERCP)-guided biliary stent placement across the site of the biliary leak resulted in the complete resolution of symptoms. Biloma should be included in the differential diagnosis of right upper quadrant abdominal pain. A high index of clinical suspicion is required for early diagnosis and treatment.

Highlights

A biloma is an encapsulated collection of bile outside the biliary tree and within the abdominal cavity
Initial abdominal imaging including CT scan, ultrasound and magnetic resonance cholangiopancreatography (MRCP) of the abdomen and pelvis revealed a distended gallbladder with wall thickening, but without evidence of pancreatitis or gallstones
On endoscopic retrograde cholangiopancreatography (ERCP), there was no clear evidence of contrast extravasation; a blush of contrast at the junction of the cystic duct and the common hepatic duct was seen, which correlated with the location of biloma noted on the hepatobiliary iminodiacetic acid (HIDA) scan (Figure 5)

Summary

Introduction

A biloma is an encapsulated collection of bile outside the biliary tree and within the abdominal cavity. On endoscopic retrograde cholangiopancreatography (ERCP), there was no clear evidence of contrast extravasation; a blush of contrast at the junction of the cystic duct and the common hepatic duct was seen, which correlated with the location of biloma noted on the HIDA scan (Figure 5). ERCP showing dilated bile duct with peribiliary duct collection at the site of percutaneous biliary drainage catheter (arrow). Since there was clear evidence of bile in the percutaneous drain with no clinical or endoscopic evidence of the bile leak, a 10-French plastic stent was placed in the CBD across the junction of the bile duct with the cystic duct where a blush of contrast was seen on ERCP (Figure 6). Upon follow-up five weeks after the intervention, a repeat ERCP showed that the bile leak had resolved, and the plastic stent was removed

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Disclosures

Ziessman HA