Biloma during Steroid Therapy for Minimal Change Nephrotic Syndrome.

Abstract

A 27-year-old man, who had been on steroid therapy for 2 months for his nephrotic syndrome, suddenly developed intra-abdominal bile collection (biloma). He had no previous history of abdominal surgery, trauma, or any disease of the hepatobiliary system. The cause of the biloma formation was due, probably, to cholecystitis in the absence of calculi and a pinhole size perforation in the wall of gall bladder. It was assumed to be closely related to the high-dose steroid therapy over a prolonged period, which would likely suppress the repair process of the locally damaged biliary system. (Internal Medicine 32: 543-546, 1993)

Subcapsular liver biloma due to gallbladder perforation after acute cholecystitis

“…However, the tests are non‐specific and similar findings can also be obtained by other cystic lesions, so a differential diagnosis includes seroma, hematoma, abscess, cyst, lymphocele and pseudocyst 8,11,12 . The diagnosis of biloma can be made by demonstrating a communication with the biliary tree, as in the present case, 10 or by image‐guided needle aspiration of the fluid and a subsequent chemical analysis of the aspirate 8,11 …”

“…Biloma is a rare condition and is defined as a localized, often encapsulated collection of bile outside the biliary tree, 6,7 either extrahepatic or intrahepatic 8 . The main causative factors of biloma formation are iatrogenic, including biliary surgery, percutaneous transhepatic cholangiography, endoscopic retrograde cholangiopancreatography, liver biopsy, biliary drainage procedures 9–11 and traumatic injury.…”

“…CT scans and US are useful in establishing the diagnosis by revealing a fluid collection. US in particular usually shows a well circumscribed, encapsulated anechoic or hypoechoic lesion with prominent distal sonic enhancement and may show a small amount of debris or a few septations 7,10 . CT scan can identify and localize the biloma and is optimal for showing their nature, distribution and regional anatomy 11 .…”

A giant and insidious subphrenic biloma formation due to gallbladder perforation mimicking biliary cystic tumor: A case report

“…On US images, bilomas present as well-circumscribed, anechoic and encapsulated masses with or without internal debris and septa (7,12). However, a variety of intraperitoneal cystic lesions have overlapping features, including hematoma, hepatic cyst, abscess and pseudocyst.…”

“…Radiological evaluations serve a vital role in early identification and appropriate intervention. Although focal disruption of the wall is the definitive imaging finding of GBP, small perforations may escape detection, and preoperative diagnosis therefore remains challenging (7).…”