Abstract
INTRODUCTION
Biloma is the collection of bile outside the biliary tree and can be intra or extra hepatic. 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 REPORT
A 32 years old female presented as lump abdomen in epigastric region. Blood investigations were normal. Chest radiographs were unremarkable. Ultrasound examination revealed two cystic lesion in relation to 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
32 year old female admitted in emergency with complain of acute pain in abdomen since 2 days. Ultrasound shows contracted gallbladder withstone along with focal collection in perihepatic and peri gallbladder region extending into subcutaneous plane with cbd stone.. Ultrasound guided pigtail catheter drainage of the collection was done. After 5 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.