Biloma: An unusual complication in a patient withpancreatic cancer

Abstract

The term biloma describes an encapsulated collection of bile within the abdomen, usually secondary to bile duct disruption. The commonest causes reported in the literature are iatrogenic (secondary to hepatobiliary surgery), trauma or complications due to choledocholithiasis. A few cases have been reported as complications of cholangiocarcinoma or acute cholecystitis. We report the case of a 64-year-old man initially diagnosed with a non-obstructive malignancy of the pancreas, who developed a spontaneous intrahepatic biloma 8 mo later. This was identified following a 1-wk history of fever, rigors and icterus. The biloma was identified on computed tomography and subsequently drained under ultrasound guidance. Forty-eight hours later, a stent was inserted endoscopically into his common bile duct and he made an uneventful in-hospital recovery. We believe this is the first documented case of spontaneous intrahepatic biloma to occur secondary to pancreatic malignancy.

Management Of Localised Postoperative Bile Collections

“…The biloma was identified on computed tomography and subsequently drained under ultrasound guidance. Forty-eight hours later, a stent was inserted endoscopically into his common bile duct and he made an uneventful in-hospital recovery without operation [10].…”

An Unexpected Complication in a Pediatric Patient With Sclerosing Cholangitis: A Huge Spontaneous Biloma

“…Spontaneous biloma is extremely rare, and choledocholithiasis and cholangiocarcinoma are reported as etiologic factors in most of these cases [3]. Rare causes have been reported, such as primary pancreatic malignancy [1], sickle cell disease [7,8] and gallbladder tuberculosis [9]. We emphasized that the spontaneous biloma was related with sclerosing cholangitis because there was no risk factor for developing a biloma in this case, including trauma, gallstone, abdominal intervention from biopsy or surgery, or malignancy in the CBD and/or periampullary region.…”

“…One currently suggested pathogenic mechanism is increased intraductal pressure due to obstructive lesions or infarctions of the bile ducts. Trivedi et al reported the first patient with spontaneous biloma, which occurred secondary to pancreatic malignancy, in 2009 [1]. They commented that an acute elevation in biliary pressure is unusual because of the relatively slow onset of ductal obstruction that occurs with pancreatic neoplasms [1].…”

“…Trivedi et al reported the first patient with spontaneous biloma, which occurred secondary to pancreatic malignancy, in 2009 [1]. They commented that an acute elevation in biliary pressure is unusual because of the relatively slow onset of ductal obstruction that occurs with pancreatic neoplasms [1]. Middleton et al reported that spontaneous biloma occurred as a possible sequel of hepatic infarction in a patient with sickle cell disease [8].…”

“…Biloma is a rare disease defined as an encapsulated collection of bile due to disruption of the biliary tree [1]. The majority of bile leaks occur secondary to traumatic or iatrogenic injury, including abdominal surgery, laparoscopic surgery, and percutaneous catheter drainage.…”