Gallbladder perforation with formation of hepatic subcapsular biloma, treated with endoscopic nasobiliary drainage

Abstract

A 66-year-old man presented with right upper quadrant pain and progressive dyspnea for 2 days. He had history of chronic obstructive pulmonary disease and chronic kidney disease. On admission, he was febrile and had sinus tachycardia. Laboratory findings showed an elevated white blood cell count of 18.01 × 109/L with 92.1 % neutrophils. Liver function tests revealed normal alanine aminotransferase (14 U/L [3 – 37 U/L]), normal total bilirubin (0.6 mg/dL [0 – 1.0 mg/dL]), and elevated alkaline phosphatase (157 U/L [39 – 120 U/L]). Ultrasonography showed a big encapsulated cystic lesion in right upper quadrant of abdomen, with amorphous echogenic material within the lesion. The gallbladder was small in size and a 0.9-cm gallstone was noted ([Fig. 1]).