Spontaneous biloma: a case report

Valle, Valentina; Eshja, Esmeralda; Bassi, Ernesto

doi:10.1007/s40477-013-0053-6

Cited by 13 publications

(19 citation statements)

References 8 publications

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“…Corresponding to the literature, icterus, fever and abdominal pain were the leading clinical symptoms [7–9, 16]. One third of biloma patients were asymptomatic as already reported by Safdar et al [7].…”

Section: Discussionmentioning

confidence: 75%

A retrospective clinical and microbial analysis of 32 patients with bilomas

et al. 2019

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Background Bilomas are defined collections of bile fluids mainly caused by iatrogenic injuries of the bile duct system. Owing to the infrequency of this disease, studies addressing bilomas are rare. Methods By using an endoscopic database, this retrospective study identified 32 patients with bilomas treated between 2004 to 2015, in order to analyse aetiology, clinical presentation, spectrum of pathogens, and resolution rate of bilomas. Results 65.6% of the study population (21/32) developed bilomas after surgery and 21.9% (7/32) after endoscopic retrograde cholangiography (ERC). Icterus, fever, and abdominal pain were the leading symptoms. 93.9% (46/49) of microbiological bile cultures revealed a positive microbiology. The predominant microorganisms were the group of Enterobacteriaceae (43.0%, 52/121), followed by Enterococcus spp. (32.2%, 39/121), and Candida spp. (9.1%, 11/121). Multiresistant bacteria like Enterobacteriaceae were isolated from one quarter of all patients. Single or multimodal treatment resulted in an overall complication rate of 4.8% (9/188). Clinical follow-up analysis showed a complete resolution rate of 78.3% for interventional therapy and 80% in the non-interventional group. Conclusions Pathogen spectrum of bilomas mainly comprises the group of Enterobacteriacae and Enterococcus spp., with a high proportion of multiresistant bacteria. Different interventional approaches are available for biloma drainage, which seem to be safe and effective for most patients. Trial registration German Clinical Trials Register DRKS00015208 , retrospectively registered.

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Section: Discussionmentioning

confidence: 75%

A retrospective clinical and microbial analysis of 32 patients with bilomas

et al. 2019

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“…Mean time for developing post-cholecystectomy biloma is about 2 weeks from the surgery, but in the literature, cases up to 5 years from the surgery have been reported. In rare cases, biloma can present on postoperative day 5–15 and infrequently, past 1 year [ 4 , 7 ]. In this study, the patient presented with complaints of a painful lump in the upper abdomen and no jaundice two months after laparoscopic cholecystectomy.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous cystic biloma after laparoscopic cholecystectomy treated conservatively: A case report

Handaya

Fauzi

Andrew

et al. 2021

Annals of Medicine &Amp; Surgery

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Introduction Biloma forms due to common bile duct (CBD) injury as a laparoscopic cholecystectomy complication. Spontaneous localized biloma forming cysts in the biliary duct is rare. Presentation of case We report a 47-year-old male with complaint of a painful lump in the upper abdomen two months after laparoscopic cholecystectomy. Magnetic resonance cholangiopancreatography (MRCP) found a large epigastric cyst mass, without any signs of CBD injury. Patient was managed with percutaneous drainage in the outpatient clinic and kept the contents of the drainage bag for evaluation. After two months follow-up the outcome was favorable. Discussion Biloma forming cysts is a very rare complication post laparoscopic cholecystectomy. Biloma most common occurs as free fluid in the abdominal cavity. Clinical diagnostics, intraoperative historical evaluation and support with MRCP may determine the treatment options. Decision to manage with non-operative procedures by percutaneous drainage and evaluations of the patient in the outpatient clinic had a favorable outcome. Conclusion Post laparoscopic biloma cysts are a very rare case. Management with percutaneous drainage in an outpatient clinic and ambulatory drainage is an effective and safe procedure.

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“…The complete resolution of smaller bilomas may result with imaging-guided percutaneous drainage. A spontaneous resolution of bilomas with diameter 4 cm or higher is rare [3]. Untreated symptomatic patients and those with large bilomas (4 cm or greater diameter) are at risk for severe complications, such as biliary peritonitis, sepsis, pancreatitis, necrotizing fasciitis, abdominal abscess, gastrointestinal bleeding, pulmonary embolism, and respiratory failure [3].…”

Section: Discussionmentioning

confidence: 99%

“…The most common etiologies include choledocholithiasis, abdominal trauma, and iatrogenic causes, such as postlaparoscopic cholecystectomy or hepatobiliary interventions [2]. A rare etiology of biloma is a spontaneous bile leak (SBL), where a specific cause remains unidentifiable and is usually a diagnosis of exclusion [3]. The clinical presentation of a biloma is variable, ranging from an incidental finding on imaging in an otherwise asymptomatic patient, to abdominal fullness, pain, fever, and jaundice, to very rarely, peritonitis without fever [3].…”

Section: Introductionmentioning

confidence: 99%

“…A rare etiology of biloma is a spontaneous bile leak (SBL), where a specific cause remains unidentifiable and is usually a diagnosis of exclusion [3]. The clinical presentation of a biloma is variable, ranging from an incidental finding on imaging in an otherwise asymptomatic patient, to abdominal fullness, pain, fever, and jaundice, to very rarely, peritonitis without fever [3]. Abdominal imaging, such as abdominal ultrasound (US), CT scan, magnetic resonance cholangiopancreatography (MRCP), and cholescintigraphy using 99mTc hepatobiliary iminodiacetic acid (HIDA) scan, plays a crucial role in the identification of a biloma and in ruling out other possible etiologies [4].…”

Section: Introductionmentioning

confidence: 99%

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Biloma: A Rare Manifestation of Spontaneous Bile Leak

Yousaf

D'Souza

Chaudhary

et al. 2020

Cureus

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A biloma is an intrahepatic or extrahepatic encapsulated collection of bile outside of the biliary tree and within the abdominal cavity. Hepatobiliary interventions and laparoscopic cholecystectomy are the most common etiologies of biloma followed by abdominal trauma, choledocholithiasis, and biliary dilation secondary to biliary stricture. We report a case of a 91year-old female who presented to the emergency room with an acute onset of epigastric and right upper quadrant sharp pain for one day that radiated to the back, and was associated with two to three episodes of vomiting. Initial abdominal imaging including CT scan, ultrasound and magnetic resonance cholangiopancreatography (MRCP) of the abdomen and pelvis revealed a distended gallbladder with wall thickening, but without evidence of pancreatitis or gallstones. Hepatobiliary iminodiacetic acid (HIDA) scan findings were consistent with extrahepatic biliary leakage into the peritoneum. A cholangiogram demonstrated a perihepatic biloma. A combined approach using fluoroscopic-guided biloma drainage and endoscopic retrograde cholangiopancreatography (ERCP)-guided biliary stent placement across the site of the biliary leak resulted in the complete resolution of symptoms. Biloma should be included in the differential diagnosis of right upper quadrant abdominal pain. A high index of clinical suspicion is required for early diagnosis and treatment.

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Spontaneous biloma: a case report

Cited by 13 publications

References 8 publications

A retrospective clinical and microbial analysis of 32 patients with bilomas

A retrospective clinical and microbial analysis of 32 patients with bilomas

Spontaneous cystic biloma after laparoscopic cholecystectomy treated conservatively: A case report

Biloma: A Rare Manifestation of Spontaneous Bile Leak

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