Huge Biloma in a child with unusual presentation

Professor Samir Ibrahim Hasan Alsaffar

doi:10.33899/mmed.2021.129534.1077

Abstract

Background: The term "biloma" describes a well-demarcated, encapsulated or not, intra-abdominal (extrahepatic or intrahepatic) bile collection outside the biliary tree, secondary to iatrogenic, traumatic or spontaneous rupture of the biliary tree. The clinical symptoms of bilomas are usually nonspecific, ranging from no symptoms to abdominal pain, jaundice, and fever. There were only few cases of huge bilomas in the literature but no report of conincidental extrahepatic and intrahepatic biloma in the same patient. Case report: We report herein a 12 years boy with huge biloma (20cm in vertical diameter) after blunt abdominal trauma, presented with unique clinical features of marked emaciation and diffuse abdominal distention . To our knowledge this is the largest biloma ever reported in paediatric age group and the first biloma with such unique clinical presentation, and the first case with both extrahepatic and intrahepatic bilomas in single setting. Conclusion: Although biloma is rare condition but it needs to be considered in differential diagnosis of diffuse abdominal distension in patients following abdominal trauma or surgery.

Highlights

The term "biloma" describes a well-demarcated, encapsulated or not, intra-abdominal bile collection outside the biliary tree, secondary to iatrogenic, traumatic or spontaneous rupture of the biliary tree
Cholecystectomies whether open or laparoscopic are the main causes of biloma formation 9,10
In our child the biloma was developed about 2 months after the trauma, and its pathogenesis can be explained as that of secondary tissue necrosis that lead to bile leakage

Summary

Introduction

The term "biloma" describes a well-demarcated, encapsulated or not, intra-abdominal (extrahepatic or intrahepatic) bile collection outside the biliary tree, secondary to iatrogenic, traumatic or spontaneous rupture of the biliary tree. .‫ط‬ٚ‫ َفس انًش‬ٙ‫س انصفشأ٘ خبسج انكبذ ٔداخم انكبذ ف‬ٛ‫انك‬ ‫ش َبفزة‬ٛ‫ سى) بعذ اصببت ؼ‬12 ٙ‫س صفشأ٘ ظخى .‫ ٔدج ٔادذ‬ٙ‫ٍ خبسج انكبذ ٔداخم انكبذ ف‬ٛ‫كٌٕ يٍ كلا انُٕع‬ٚ ٌ‫عب بب‬ٚ‫الأٔنٗ ا‬ ٙ‫ق‬ٚ‫ص انخفش‬ٛ‫ الاعخببس عُذ انخشخ‬ٙ‫جب أخزْب ف‬ٚ َّ‫ إلا أ‬، ‫هٕيب) يشض َبدس‬ٚ‫س انصفشأ٘ CT scan showed two intrahepatic cystic collections.

Results

Conclusion