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Biloma

Leyla Azmoun, MD
Piran Aliabadi, MD
B Leonard Holman, MD

November 14, 1995

Presentation

Two weeks after a laparoscopic cholecystectomy, a 24-year-old woman presented to the emergency room with right upper quadrant (RUQ) pain and fever. On physical examination, she had a temperature of 39 degrees Celsius, marked RUQ tenderness and mild peritoneal signs. Her white blood cell count (WBC) was 14.5 K/ml.

Imaging Findings

Cholescintigraphy at 15 min. intervals

Supine and upright plain radiographs of the abdomen revealed mild ileus but no bowel obstruction.

Serial Tc-99m-IDA scintigraphy demonstrates accumulation of bile in the gallbladder fossa at 15 minutes (arrow) with progressive accumulation of bile in a subhepatic pocket at 1 hour (arrow). There is normal visualization of the common bile duct (arrow) and gastrointestinal tract (arrow). These findings are consistent with active biliary leakage into a biloma.

Diagnosis

Biloma

Discussion

Bilomas are often seen following biliary tract surgery although they can also occur after trauma or erosion into the biliary tree from a malignant or inflammatory process. Cholescintigraphy using Tc-99m-IDA derivatives is a very sensitive method for detecting and monitoring bile leaks. Most of the leaks stop spontaneously and can be managed conservatively. Biliary scintigraphy or sonography can be used to follow the quantity of biliary leakage and the size of the biloma. If biliary leakage persists or patient's clinical situation deteriorates, biliary stenting via the retrograde (ERCP) or percutaneous route or surgical repair should be performed.

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