DOI: https://dx.doi.org/10.18203/2349-2902.isj20221427
Published: 2022-05-26

Biloma a pseudocyst mimic

Kalyan Kumar M. S., Vijayalakshmi V., Sampath Kumar B., Mohamed Farook M., Kannan R.

Abstract


Bilioma is defined as an encapsulated collection of bile inside or outside of the biliary tree within the abdominal cavity. We report a case of a 56 years old male presented with complaints of abdominal distention and abdominal pain for 1 month whom on initial imaging, a diagnosis of pseudocyst of pancreas was suspected but on further imaging with MRCP, a biloma formation was found. Intervention involving Hepatobiliary tree is the most common etiology of a biloma formation. Biloma can also be caused by abdominal trauma and choledocholithiasis. In terms of treatment, small and uncomplicated cases need no intervention as spontaneous resolution is expected and in severe cases a combined approach using percutaneous drainage of biloma and endoscopic retrograde cholangiopancreatography (ERCP)-guided biliary stent placement across the site of the biliary leak or surgical hepaticojejunostomy or just image guided percutaneous drainage alone would be the treatment choice. Biloma should be included in the differential diagnosis of a large cystic lesion of the abdomen.


Keywords


Bilioma, Spontaneous bile leak, Complications of hepatobiliary interventions, Percutaneous drainage, Pseudocyst mimic

Full Text:

PDF

References


Lee CM, Stewart L, Way LW. Postcholecystectomy abdominal bile collections. Arch Surg. 2000;135:538-42.

Bas G, Okan I, Sahin M, Eryimaz R. Is1k A: Spontaneous biloma managed with endoscopic retrograde cholangiopancreatography and percutaneous drainage: a case report. Med Case Rep. 2011;5:3.

Lee JH, Suh JI. A case of infected biloma due to spontaneous intrahepatic biliary rupture. Korean J Intern Med. 2007;22:220-4.

Trivedi P-J, Gupta P, Phillips-Hughes, Ellis A. Biloma: an unusual complication in a patient with pancreatic cancer. World Gastroenterol. 2009;15:5218-20.

Binmoeller KF, Katon RM, Shneidman R. Endoscopic management of postoperative biliary leaks: review of 77 cases and report of two cases with biloma formation. Am J Gastroenterol. 1991;86:227-31.

Faisal Uddin M, Bansal R, Itikhar PM, Khan I, Arastu AH. A rare case report of biloma after cholecystectomy. Cureus. 2019;11:e5459.

Kalfadis S, Ioannidis O, Botsios D, Lazaridis C: Subcapsular liver biloma due to gallbladder perforation after acute cholecystitis. Dig Dis. 2011;12:412-4.

Vadvala HV, Arellano RS. Imaging and intervention of biliary leaks and bilomas. Dig Dis Interv. 2017;1:14-21.

Della ValleV, Eshja E, Bassi EM. Spontaneous biloma: a case report. Ultrasound. 2015;18:293-6.

Thomas S, Jahangir K. Noninvasive imaging of the biliary system relevant to percutaneous interventions. Semin Intervent Radio1. 2016;33:277-82.

Ziessman HA. Nuclear medicine hepatobiliary imaging. Clin Gastroenterol Hepatol. 2010;8:111-6.

Gould L, Patel A. Ultrasound detection of extrahepatic encapsulated bile: "biloma". AJR Am J Roentgenol. 1979;132:1014-5.

Akhtar MA, Bandyopadhyay D, Montgomery HD, Mahomed A. Spontaneous idiopathic subcapsular biloma. Hepatobiliary Pancreat Surg. 2007;14:579-81.

Fujiwara H, Yamamoto M, Takahashi M. Spontaneous rupture of an intrahepatic bile duct with biloma treated by percutaneous drainage and endoscopic sphincterotomy. Am J Gastroenterol. 1998;93:2282-4.

Agalianos C, Passas I, Sideris I, Davides D, Dervenis C. Review of management options for pancreatic pseudocysts. Transl Gastroenterol Hepatol. 2018;3:18.

Yousuf MN, D'souza RG, Chaudry F. Biloma: A Rare manifestation of spontaneous bile leak. Cureus. 2020;e8116.