Post Laparoscopic Cholecystectomy Biloma in a Child Managed by Endoscopic Retrograde Cholangio-Pancreatography and Stenting: A Case Report

Abstract

Laparoscopic cholecystectomy, though an uncommon surgical procedure in paediatric age group is still associated with a higher risk of post-operative bile duct injuries when compared with the open procedure. Small leaks from extra hepatic biliary apparatus usually lead to the formation of a localized sub-hepatic bile collection, also known as biloma. Such leaks are rare complication after laparoscopic cholecystectomy, especially in paediatric age group. Minor bile leaks can usually be managed non-surgically by percutaneous drainage combined with endoscopic retrograde cholangio-pancreatography (ERCP). However, surgical exploration is required in cases not responding to non-operative management. If not managed on time, such injuries can lead to severe hepatic damage. We describe a case of an eight-year-old girl who presented with biloma formation after laparoscopic cholecystectomy who was managed by ERCP.

<p>Biloma At The Lesser Sac Post Laparoscopic Cholecystectomy</p>

“…The drainage of a biloma because of partial injury of the accessory duct was acceptable as a first step in management, as further steps depend on the patient's progress 10…”

Sonographic Detection of a Urinoma/Biloma Combination

“…Delayed management can result in significant hepatic damage. 11 After treatment, sonographic follow-up is recommended. CT can be a useful diagnostic tool in these cases, but bile duct injuries tend to be visualized more clearly sonographically.…”

“…A sonographic-guided percutaneous aspiration can helpful with diagnosis, as laboratory tests may reveal that the aspirated fluid contains a high concentration of serum bilirubin, which indicates bile leakage, and will confirm the diagnosis. 11 This aspiration can also be therapeutic and aid in resolving the biloma. Most small leaks can be managed by percutaneous drainage under imaging guidance, while larger leaks may require stent placement such as in this case.…”

Percutaneous rendezvous technique for the management of a bile duct injury

“…Bile duct injuries are a potential complication of cholecystectomy and can range from mild to severe in their consequences [2] . As a result of these injuries, bile leaks can occur, causing intra-abdominal collections, fistula formation, or peritonitis [3] .…”

“…The incidence of bilomas after laparoscopic cholecystectomy has been reported to be 2.5%. Patients with a biloma typically present with right upper quadrant or epigastric pain, jaundice, elevated liver function tests, abdominal distention, fever, and leukocytosis [2] . Biliary leakage can also present as in this case with increased bilious output from surgical drains [3] .…”