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Spontaneous biloma formation is a very rare condition, which mandates immediate treatment.
An 80-year-old Caucasian man was referred to our department with a diagnosis of intra-abdominal collection located in his right upper quadrant. Further radiological examination demonstrated multiple calculi in his gallbladder and common bile duct. Our patient...
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Context 1
... viral hepatitis marker tests were all negative. A repeat CT revealed a large right hepatic subcapsular collection with a size of 18.9 cm (Figure 1). Abdominal magnetic reso- nance imaging (MRI) demonstrated multiple common bile duct (CBD) stones with an enlarged biliary tree, and a large subcapsular fluid collection extending around the lower margin of his right hepatic lobe ( Figure 2) without any direct communication with the biliary sys- tem. ...Similar publications
Background:
EUS-guided rendezvous procedure (EUS-RV) can be done by the transhepatic (TH) or the extrahepatic (EH) route. There is no data on the preferred access route when both routes are available.
Study aim:
To compare the success, complications, and duration of hospitalization for patients undergoing EUS-RV by the TH or the EH route.
Patie...
Introduction: Magnetic resonance cholangiopancreatography (MRCP) is an important diagnostic tool in evaluating patients with biliary laboratory abnormalities after orthotopic liver transplant (OLT) to determine the need for more invasive procedures, such as endoscopic retrograde cholangiopancreatography (ERCP), which can deliver therapeutic interve...
Background: Common bile duct (CBD) stones are the second most common complication of gall bladder stones. The best management of patients with CBD stones remains controversial. The aim of this study was to evaluate the methods of laparoscopic CBD exploration (LCBDE).Methods: This prospective study was conducted on 30 patients with CBD stones throug...
Background
This study aimed to compare the efficacy and safety of laparoscopic cholecystectomy combined with intraoperative endoscopic retrograde cholangiopancreatography (LC-IntraERCP) and laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration (LC-LCBDE) to determine which one-stage therapeutic strategy provides bette...
Choledochocystolithiasis can be managed by endoscopic retrograde cholangiopancreaticography (ERCP) or laparoscopically by transcystic (TC) or transductal (TD) stone extraction.
The aim of this study was to systematically review safety and effectiveness of combined endoscopic/laparoscopic management versus total laparoscopic management for choledoch...
Citations
... Другим важным методом диагностики является ЭРХПГ, по результатам которой можно определить экстравазацию контрастного препарата [2,[37][38][39][40][41][42][43] или выявить косвенные признаки заболевания (холедохолитиаз, стриктура протока) [6,8,12,16,32,44,45]. В 3 наблюдениях применили билиосцинтиграфию [43,44,46], при этом в 2 наблюдениях определена миграция радиофармпрепарата за пределы билиарного тракта [43,44]. Рядом авторов отмечена высокая прогностическая значимость концентрации билирубина в асцитической жидкости >103 мкмоль/л, что позволяет верно определять присутствие желчи в брюшной полости [36]. ...
... Для локализованных форм перфораций с развитием внутрипеченочных и подкапсульных скоплений желчи вариантом выбора является чрескожное чреспеченочное дренирование скопления под контролем УЗИ или МСКТ. В 4 наблюдениях такой способ лечения был дополнен ЭПСТ с лит экстракцией [3,32,41,47], в 5 -эндоскопическим стентированием [32,34,[39][40][41]. В 3 наблюдениях чрескожное дренирование было самостоятельным методом лечения [29,31,35]. ...
... Для локализованных форм перфораций с развитием внутрипеченочных и подкапсульных скоплений желчи вариантом выбора является чрескожное чреспеченочное дренирование скопления под контролем УЗИ или МСКТ. В 4 наблюдениях такой способ лечения был дополнен ЭПСТ с лит экстракцией [3,32,41,47], в 5 -эндоскопическим стентированием [32,34,[39][40][41]. В 3 наблюдениях чрескожное дренирование было самостоятельным методом лечения [29,31,35]. ...
Aim . To evaluate different therapeutic and diagnostic approaches in spontaneous bile duct perforation.
Materials and methods . The present study involved the reports on spontaneous perforations in the bile duct system, published from 01.01.2000 to 01.06.2022 and selected by structured search in PubMed/Medline database.
Results . As a result, 58 articles describing 71 patients were selected for the study. The most frequent symptoms of the disease included abdominal pain (92.9%), fever (39.4%), and jaundice (33%). The provisional diagnosis was made correctly in 52.1% of cases. The development of the disease was most often associated with choledocholithiasis (38%). Bile ducts perforation of the left hepatic lobe was revealed in 40.6% of cases, perforation of the common bile duct – in 35.5%. Bile duct perforation resulted in peritonitis in 42.2% of patients and bile accumulation or abscess in 30.9%. Encapsulated and intrahepatic accumulation of bile was found in 18.3% of cases. Management of perforations with development of encapsulated and intrahepatic bile accumulation included combined treatment, embracing percutaneous transhepatic drainage and endoscopic methods. Perforation of bile ducts with development of extensive forms of the disease required two-stage treatment. The first stage involved lavage of the abdominal cavity and decompression of the biliary tract. The second stage involved resective and reconstructive surgery to eliminate the cause of the perforation. The mortality rate was 5.6%.
Conclusion . Spontaneous perforation in the bile duct system is a rare pathological state appeared as a complication of hepatopancreaticoduodenal diseases. Its management requires greater awareness of abdominal surgeons. The surgical strategy is based on correctly diagnosed and staged treatment tactics, which allows the incidence of complications and mortality rate to be reduced.
... However, depending on the etiology of the biloma, further surgical interventions would be required, such as endoscopic retrograde cholangiopancreaticography (ERCP) and cholecystectomy for choledocholithiasis, surgical resection for masses, etc. In cases of persistent biliary leak, ERCP and stenting can be utilized [13]. Treatment with antibiotics is required when blood and biliary fluid cultures are positive. ...
We report a case of an 86-year-old Hispanic male who presented with generalized itching and jaundice. Computed tomography (CT) imaging revealed a hepatic mass and an extensive spontaneous biloma, a condition rarely associated with malignancy. Subsequent biopsy of the mass confirmed moderately differentiated adenocarcinoma of the pancreaticobiliary tract. The patient underwent successful percutaneous drainage of the biloma and was discharged with a plan for further outpatient management. This case study highlights a rare manifestation of spontaneous biloma related to malignancy, broadening the clinical understanding of its association with malignancy, diagnosis, and management.
... Perforations of the biliary tree in adults are extremely rare and are mainly caused by iatrogenic injury or severe abdominal trauma [7]. However, there are a small collection of cases of spontaneous biloma, reported in the literature. ...
... The pathophysiology of the spontaneous perforation of the biliary tree remains to be completely elucidated, but some mechanisms have already been proposed, namely: erosion of the bile duct wall by biliary stones; persistently increased intraductal pressure due to an obstruction of the distal bile duct; thrombosis of a vessel supplying the bile duct wall or even intramural infection of the duct as a result of cholangitis [2]. As previously mentioned, the clinical presentation of biloma is extremely variable, ranging from non-specific abdominal pain to severe biliary sepsis, depending upon the location, size and aetiology of the biloma, frequently delaying the diagnosis [4,7]. ...
... The diagnosis of a biloma is based on the clinical presentation and in the radiological abdominal imaging. The abdominal US is usually the initial imaging in the evaluation of RUQ (right upper quadrant) pain, and it is capable of evaluating the presence of biloma and sometimes the underlying pathology and excluding differential diagnosis, such as hematoma, seroma, liver abscess, cysts or pseudocysts [7,8]. On the other hand, CT plays a crucial role, since it can define the collection and the integrity of the retroperitoneal organs with more accuracy. ...
Introduction and importance:
Spontaneous perforation of the biliary tree, resulting in retroperitoneal biloma in adults is an extremely rare condition, and may unfold to a potentially fatal outcome, particularly when the diagnosis and definitive treatment are delayed.
Case presentation:
We report a case of a 69-year-old male who presented to the emergency room with abdominal pain, localized to the right quadrants, associated with jaundice and dark-coloured urine. Abdominal imaging including CT scan, ultrasound and magnetic resonance cholangiopancreatography (MRCP) revealed a retroperitoneal fluid collection, a distended gallbladder with wall thickening and lithiasis, as well as a dilated common bile duct (CBD) with choledocholithiasis. The analysis of the retroperitoneal fluid obtained by CT-guided percutaneous drainage was consistent with biloma. A combined approach of biloma percutaneous drainage and endoscopic retrograde cholangiopancreatography (ERCP)-guided stent placement in the CBD with biliary stones removal was successful in the management of this patient, despite the fact that the perforation site could not be detected.
Clinical discussion:
The diagnosis of biloma is based mainly on clinical presentation and abdominal imaging. If urgent surgical intervention is not indicated, pressure necrosis and perforation of the biliary tree may be avoided by timely percutaneous aspiration of the biloma and ERCP to remove the impacted stones in the biliary tree.
Conclusion:
Biloma should be considered in the differential diagnosis of a patient presenting with right upper quadrant or epigastric pain and an intra-abdominal collection on imaging. Efforts should be made in order to offer a prompt diagnosis and treatment to the patient.
... It is mainly caused by iatrogenic injury or any abdominal trauma involving bile duct disruption, or it can occur spontaneously. The leaking bile, by virtue of the detergent and tissue destroying action of bile acids, creates a low-grade inflammation, resulting in a thin capsule or adhesions resulting in an isolated collection called biloma [2] that can reach in some rare cases a large size. ...
Biloma is a severe complication that can result from bile duct disruption or hepatic trauma. It can occur after biliary surgery such as cholecystectomy or an endoscopic retrograde cholangiopancreatography manipulation and endoscopic biliary sphincterotomy. We present the case of a 59-year-old man admitted for jaundice, with pain in his right flank and fever, 10 days after an endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for an ill-defined pancreatic lesion, associated with an infected biloma. Severe complications can occur after an EUS-FNA; therefore, this diagnosis should not be neglected after the intervention in symptomatic patients, to ensure an early and proper treatment.
... Bilomas are encapsulated collections of bile outside or inside biliary tract within abdominal cavity (1). In humans, bilomas were reported to be results from abdominal trauma, spontaneous leakage of the biliary tree, or iatrogenic injury (2)(3)(4)(5). Iatrogenic damage to the biliary tract is commonly associated with laparoscopic cholecystectomy (6). Bilomas in veterinary medicine has been described to be developed after surgery of intrahepatic portosystemic shunt (7), cholecystectomy (8), and open liver biopsy (9) and associated with trauma (10). ...
... The current case had no history of biliary surgery, liver biopsy, or abdominal trauma, suggesting an unknown cause of biloma. Previous studies showed that the cause of bilomas in humans included spontaneous leakage of the intrahepatic bile duct (3,4). The current dog may have developed biloma spontaneously. ...
... The most common therapeutic approach in human patients with bilomas is percutaneous drainage (3,4). Studies in veterinary medicine involving two dogs with bilomas who underwent percutaneous drainage showed that both dogs had good outcomes without such a surgical approach for biloma (8,10). ...
Bilomas are encapsulated collections of bile outside or inside the biliary tract within the abdominal cavity. For diagnostic and therapeutic approaches, it is important to identify the origin of bile leaks from the biliary tract. This case report describes the usefulness of drip infusion cholangiography with computed tomography (DIC-CT) for detecting the site of bile leakage in a dog with biloma. A 10-year-old, castrated male Pomeranian dog was referred to our department for gastrointestinal signs. Abdominal ultrasonography detected gallbladder mucocele without evidence of defect on the wall and well-defined anechoic localized fluid accumulation around the right division of the liver. On the other hand, there was only a small amount of ascites in the abdominal cavity. The accumulated fluid collected through abdominocentesis had a bilirubin concentration of 11.4 mg/dl, which was more than twice as high as that in serum (0.4 mg/dl), but had absence of pyogenic bacteria. The DIC-CT with meglumine iotroxate showed two well-defined large fluid collections: one between right medial and lateral lobe and the other between the right lateral lobe and caudate process of caudate lobe. Three-dimensional DIC-CT views that the former was enhanced by the contrast agent and that it communicated with an intrahepatic bile duct of the right lateral lobe. Moreover, the DIC-CT images confirmed communication with each fluid collections. After 6 days of hospitalization, a decrease in the amount of accumulated fluid was confirmed, after which cholecystectomy was performed. The dog was discharged from the hospital without complications. No signs of bile leakage were observed on follow-up imaging on postoperative day 10. According to authors knowledge, this has been the first report to show that DIC-CT can be useful for determining the origin of bile leakage in dogs with bilomas.
... Whereas small, benign bilomas can be observed clinically. ERCP is indicated in cases where radiological treatment fails and bile leak persists (recurrent bilomas); this is to divert the flow of bile from the leak site by endoscopic manipulation of the sphincter, which includes sphincterotomy with stent placement, which is required to facilitate bile drainage [8,9]. ...
“Biloma” is a collection of bile outside of the biliary tree that could occur postoperatively in patients who undergo laparoscopic cholecystectomy or in patients with blunt trauma to the liver. Spontaneous or impulsive bilomas with no identifiable cause occur rarely. We report a case of a 60-year-old woman with no history of hepatobiliary surgery or trauma, who was admitted for right upper quadrant pain. An abdominal examination revealed tenderness in the right upper quadrant (RUQ). Her alkaline phosphatase level was 2,343 IU/L. Computed tomography of the abdomen and pelvis with contrast showed perihepatic, periduodenal, and right paracolic gutter ascites. The image-guided aspiration of the peritoneal cavity yielded greenish fluid that was determined to be bile. The cytological studies were negative for malignancy and microorganisms. The ultrasound images of the RUQ were negative for cholecystitis and gallstones, and the results of the hepatobiliary nuclear scan study (HIDA) were unremarkable. Magnetic resonance cholangiopancreatography (MRCP) revealed an intact intrahepatic and extrahepatic biliary tree and confirmed the presence of multiple lakes of bile ascites.
During the entire hospital stay, the patient remained stable without any unifying diagnosis and she was discharged with a pigtail catheter. A follow-up abdominal CT scan revealed a complete resolution of the bilomas. We consider this as a spontaneous extra- and intrahepatic biloma of unknown etiology and should be in our differentials when a patient presents with right upper quadrant abdominal pain.
... However, a large body of research defines bile leak as a broader term. Using the PubMed search function, a significant amount of literature was found that referred to "spontaneous bile leak," a term used to refer to a leakage of biliary fluid that did not follow surgical intervention of any kind [4,[9][10][11][12][13]. Spontaneous bile leak has been defined as a bile leak "where a specific cause remains unidentifiable and is usually a diagnosis of exclusion" [9]. ...
Bile leaks are a rare occurrence most often seen as a complication of cholecystectomy. Other less common etiologies include endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC), liver surgery, percutaneous drainage of liver abscesses, living donor hepatectomy, and non-iatrogenic abdominal trauma. In this case study, we present a 67-year-old female with morbid obesity who presented with abdominal pain and was diagnosed with a spontaneous bile leak. She had no history of recent surgery or abdominal trauma. CT revealed that the patient's gallbladder was located in the right lower quadrant, most likely due to mass effect from a large ventral hernia, and possible fluid collection extending from the gallbladder along the surface of the anterior inferior right hepatic lobe. Hepatobiliary iminodiacetic acid (HIDA) was performed due to a concern for cholecystitis. HIDA demonstrated a bile leak in the right upper abdomen of unknown etiology. Initially, there was a concern for gallbladder obstruction. Gastroenterology recommended magnetic resonance cholangiopancreatography (MRCP), however, MRCP was not possible due to the patient's body habitus. The patient had normal liver function tests, was tolerating oral intake, and her abdominal pain resolved, therefore, we became less suspicious of gallbladder obstruction. This case suggests that bile leak should be included in the differential diagnosis for abdominal pain even in patients who have not had recent abdominal surgery or procedures. This case also highlights the unique anatomical finding of a right lower quadrant gallbladder secondary to mass effect from a large ventral hernia.
... Bilomas are mainly caused by iatrogenic or traumatic injuries to biliary passages 1,5,6 . However there are few reports of spontaneous bilomas in the literature 1,8 . Iatrogenic injury to biliary passages following abdominal surgery is the most common cause of biloma 8 . ...
... However there are few reports of spontaneous bilomas in the literature 1,8 . Iatrogenic injury to biliary passages following abdominal surgery is the most common cause of biloma 8 . Cholecystectomies whether open or laparoscopic are the main causes of biloma formation 9,10 . ...
... Only small asymptomatic ones that may resolve spontaneously can be followed without a need for intervension 3 . Percutaneous drainage was an effective form of therapy for extrahepatic biloma that often eliminated the need for surgical drainage 8 . ...
... The most frequent cause of spontaneous biloma is choledocholithiasis [5,7]. Less commonly reported causes are malignant biliary tree tumors, acute cholecystitis, hepatic infarction and abscess, obstructive jaundice, and tuberculosis [8,9]. The precise mechanism underlying spontaneous biloma development remains unclear. ...
... A search of case reports in the MEDLINE database from 2001 to 2019 using the term "spontaneous biloma" identified 28 adult patients (from 19 authors) with a spontaneous biloma [5,8,9,11,[15][16][17][18][19][20][21][22][23][24][25][26][27][28], including our case ( Table 1). The age at onset ranged from 28 to 91 years (mean±standard deviation: 66.7±12.1 years). ...
Patient: Female, 74-year-old
Final Diagnosis: Biloma
Symptoms: Epigastralgia • fever • nausea
Medication: —
Clinical Procedure: —
Specialty: Surgery
Objective
Rare co-existance of disease or pathology
Background
Spontaneous biloma is a rare non-traumatic disease in which an extrahepatic or intrahepatic bile duct perforates spontaneously with no discernable cause. We present the details of a patient with spontaneous biloma resulting from intrahepatic bile duct perforation with concurrent intrahepatic cholelithiasis and cholangiocarcinoma.
Case Report
A 74-year-old woman was admitted to our hospital with symptoms of abrupt epigastralgia, nausea, and fever. Physical examination revealed epigastric tenderness, guarding, and rebound tenderness. Laboratory test results were normal, except for elevated leukocytes, and C-reactive protein, total bilirubin, and blood urea nitrogen concentrations. Carcinoembryonic antigen and carbohydrate antigen 19-9 concentrations were also elevated. Abdominal computed tomography revealed perihepatic fluid and ascites, with common bile duct dilatation and localized cholangiectasia of B2 with areas of slight high density, which indicated an intraabdominal abscess and intrahepatic cholelithiasis. Spontaneous intrahepatic bile duct perforation was subsequently diagnosed by cholangiography via endoscopic nasobiliary drainage. Left hepatic lobectomy was performed to treat the intrahepatic cholelithiasis and spontaneous biloma. Intraoperatively, a perforation was identified at the edge of the lateral segment of the left triangular ligament, through which bile had been leaking. Histopathology revealed intraductal cholangiocellular carcinoma with intrahepatic cholangiolithiasis. The patient’s postoperative course was excellent, and she was discharged on postoperative day 16. However, cancer dissemination to the peritoneum was identified 8 months after surgery.
Conclusions
Treatment for patients with intrahepatic cholelithiasis should involve aggressive surgery because of the associated carcinogenicity. This approach reduces the risk of dissemination secondary to intrahepatic bile duct perforation.
... Bizim olgumuzda, lezyonun tipik lokalizasyonda olması, klinik ve anamnez eşliğinde ultrasonografik bulguların BT ile desteklenmesi neticesinde tanımızın yüksek ihtimal biloma olduğuna karar verildi. Tedavide, transkutanöz ve endoskopik ultrasonografi (EUS) eşliğinde drenaj ve cerrahi olarak konulan drenaj kateterleri bulunur (12,13). Bizim hastamıza hemodinamik durumundan dolayı acil eksploratif cerrahi uygulanmıştır. ...
Laparoskopik kolesistektomi sonrası gelişebilecek komplikasyonlar nadirdir. Enfeksiyon, kanama ve safra yolları hasarı bu komplikasyonlar arasında sayılabilir. Biloma, safra yollarının travmatik veya spontan hasarı sonrası intrahepatik veya ekstrahepatik yerleşim gösterebilen içi safra dolu iyi sınırlı, kapsüllü ya da kapsülsüz kistik bir lezyonudur. Laboratuvar bulguları spesifik olmayan bu hastalığın teşhisi tipik öykü (sağ üst kadran ağrısı, ateş, geçirilmiş cerrahi veya abdominal travma öyküsü ) ve doğrulayıcı radyolojik görüntü ile konur.
Biz bu olgu sunumu ile akut karın etiyolojisinde laparoskopik kolesistektomi işlemi sonrasında gelişebilecek cerrahi bir bilomanın da düşünülmesi gerektiğini vurgulamak istedik.
