Spontaneous Biliary Perforation: Biloma Resembling a Small Bowel Duplication Cyst

Goldberg, David S.; Rosenfeld, David; Underberg-Davis, Sharon J.

doi:10.1097/00005176-200008000-00024

Cited by 23 publications

(26 citation statements)

References 6 publications

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“…A biloma is a well-demarcated, encapsulated or not, bile collection outside the biliary tree caused by iatrogenic, traumatic, and spontaneous injury of the biliary tree [1][2][3][4][5][6]. It usually arises a few days or weeks after the injury [2,3,7].…”

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Double giant chronic bilomas with late presentation—9 years after cholecystectomy

Stojanović

Radojković

Jeremić

2008

Langenbecks Arch Surg

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Dear Editor, We have the intention to report of a 68-year-old man with very late presentation of two well-encapsulated giant bilomas. They occurred 9 years after open cholecystectomy, performed for an acute calculous cholecystitis. Early and late postoperative course was absolutely uneventful. Nine years later, few days before actual admission, he felt unclear symptoms of abdominal pressure and discomfort. Clinical examination and ultrasonography (US) showed large cystic masses in the right and left part of the abdomen. Computed tomography (CT) density values were 16 Hounsfield units (HU). At first, we suspected on the extrapancreatic pseudocysts. However, the pancreas was normal on the CT. At magnetic resonance imaging (MR), lesions were heterogeneously intense (T1) and homogenously hyperintense on the T2-weighted images (Figs. 1 and 2). Magnetic resonance cholangiopancreatography (MRCP) showed a normal biliary tree, with no strictures or stones and without any communication. Analysis of percutaneous needle aspirate showed clear bile with no cellular structures and bilirubin concentration of 680 mcm/L. The bilomas measured in total 5.2 L of the stagnant bile. The smaller one (16.3×10.7 cm) was located in the right part of the abdomen, into the subhepatic space and right paracolic gutter. The bigger one (22.7×11.2 cm) occupied left subphrenic space with propagation into the left paracolic gutter. Because of the failure of percutaneous drainage (incomplete drainage of the left biloma despite of the two repositioning of the drainage catheter), the patient was operated on, with simple surgical drainage. Surgical exploration and intraoperative cholangiography showed a normal biliary tree. The patient remains symptom-free with normal clinical and laboratory data more than 12 months after surgery.

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confidence: 99%

“…Our opinion is based on the fact that stagnant bile was firmly captured inside a 5-mm-thick fibrous capsule biloma. Also, the bilomas might be a result of typical spontaneous rupture of the biliary tree during the long period of the 9 years after operation [2,6].…”

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confidence: 99%

Double giant chronic bilomas with late presentation—9 years after cholecystectomy

Stojanović

Radojković

Jeremić

2008

Langenbecks Arch Surg

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“…Intraoperative exploration allows definitive localization of the perforation, and cholangiogram can evaluate the entire biliary system [10,14,19,20]. Nonobstructed biliary perforation can be managed with the placement of an external drain adjacent to the perforation with nil need for formal closure of the perforation [3,12,[19][20][21]; most perforations will close spontaneously with decompression. In perforations with distal obstruction not resolved by a cholangiogram, a biliary-intestinal anastomoses is commonly recommended [14,[19][20][21].…”

Section: Discussionmentioning

confidence: 99%

“…Nonobstructed biliary perforation can be managed with the placement of an external drain adjacent to the perforation with nil need for formal closure of the perforation [3,12,[19][20][21]; most perforations will close spontaneously with decompression. In perforations with distal obstruction not resolved by a cholangiogram, a biliary-intestinal anastomoses is commonly recommended [14,[19][20][21]. T-tube drainage is not recommended, nor is primary closure of the perforation, because of the risk of developing biliary stricture [12,20].…”

Section: Discussionmentioning

confidence: 99%

“…T-tube drainage is not recommended, nor is primary closure of the perforation, because of the risk of developing biliary stricture [12,20]. Some authors do not recommend exploration of the porta hepatis as inflammation significantly increases technical difficulty [21]. Endoscopic retrograde cholangiopancreatography has been used in both diagnostic and therapeutic modalities [11,22].…”

Section: Discussionmentioning

confidence: 99%

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