Spontaneous biloma: Report of two cases with review of the literature

Abstract

Background Biloma is the collection of bile outside the biliary tree and can be intra or extrahepatic. It is most commonly iatrogenic, secondary to surgery or percutaneous transhepatic procedures or secondary to abdominal trauma. Spontaneous bilomas are very rarely described in the literature. Case reports Case 1: A 32-years-old female presented as lump abdomen in the epigastric region. Blood investigations were normal. Chest radiographs were unremarkable. Ultrasound examination revealed two cystic lesions about left lobe of liver and cholelithiasis with choledocholithiasis. Ultrasound-guided pigtail catheter drainage of the collection was done. ERCP failed to manage the choledocholithiasis. CBD exploration with choledocholithotomy and T-tube drainage and cholecystectomy was done. The postoperative period was uneventful, and the T-tube was removed on the 10th day after a normal T-tube cholangiogram. Case 2: A 32-year-old female admitted in an emergency with a complaint of acute pain in abdomen since two days. Ultrasound shows contracted gallbladder with stone along with focal collection in perihepatic and perigallbladder region extending into the subcutaneous plane with CBD stone. Ultrasound-guided pigtail catheter drainage of the collection was done. After five days she underwent ERCP by which CBD stones were cleared. Elective laparoscopic cholecystectomy was done. Conclusion A high index of clinical suspicion is necessary for prompt recognition and its proper management. Percutaneous treatment should be considered as the first-line option for patients with spontaneous biloma. In cases of persistent bile leaks, endoscopic biliary drainage and endoscopic sphincterotomy with or without stent placement should be performed. Surgery is now performed only in cases with a persistent bile leak or for treatment of an underlying disease.

Spontaneous Biloma Secondary to Choledocholithiasis

“… 9 , 12 Surgery is reserved for patients in whom endoscopic stone extraction has failed or when there is a persistent active leak. 11 It has shown excellent outcomes. Nevertheless, it also has a high morbidity rate.…”

“…Biliary decompression through ERCP is performed to ensure the resolution of the biloma through endoscopic sphincterotomy with or without stent placement. 11 …”

Bilioma espontáneo: reporte de un caso y revisión de la literatura

“…La primera descripción de un bilioma se hizo en 1884 (1) ; sin embargo, el término bilioma (biloma en inglés) fue introducido por primera vez en 1979 (2) . Este hace referencia a una colección de bilis, que puede estar o no encapsulada, localizada fuera del árbol biliar (3) .…”

“…La ecografía, con sensibilidad del 70% (4) , y la tomografía axial computarizada, con rendimiento diagnóstico del 90% (4) , son los estudios de imagen que se realizan con más frecuencia. La intervención percutánea guiada por ecografía tiene utilidad diagnóstica y terapéutica y se recomienda como la primera línea de tratamiento (2,6) . El manejo de los pacientes puede incluir también tratamiento antibiótico, especialmente en los casos con sepsis.…”

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

“…Biloma is a collection of the bile outside the biliary tract within the abdominal cavity most commonly occurring in the subhepatic space. While the exact mechanism is not completely understood, choledocholithiasis is the most common cause of spontaneous biloma and other causes include abdominal trauma and surgery, bile duct tumors, liver infarction, percutaneous catheter drainage, transhepatic cholangiogram, and endoscopic retrograde cholangiopancreatography (ERCP) [ 1 , 2 ].…”