A rare case of hepatic sub capsular biloma after open cholecystectomy: a case report
© licensee BioMed Central Ltd. 2009
Received: 25 June 2009
Accepted: 25 August 2009
Published: 15 September 2009
Bilomas are localized collections of bile occurring usually post-operatively from an injured cystic or bile duct while most bilomas collect in the subhepatic space. We describe a rare case of hepatic subcapsular biloma after open cholecystectomy successfully treated by percutaneous drainage.
Bile leak after open or laparoscopic cholecystectomy is usually a result of minor biliary injury, although it can sometimes reveal a major duct injury. It is estimated that biloma originates from the cystic duct in more than 50% of the cases . Hepatic subcapsular bilomais an exceptional complication after cholecystectomy. We describe a rare case of a 28-year-old woman, presented 2 weeks after open partial cholecystectomy with signs of a rightsided chest pain, dyspnea and cough as a result of subcapsular biloma diagnosed by a computed tomography (CT) and, successfully treated by percutaneous drainage. There are only some cases reported in the literature of this complication after laparoscopic cholecystectomy, but according to our knowledge and from an intensive literature research, this is the first case which has been described after an open cholecystectomy.
The term biloma was introduced in 1979 by Gould and Pater to describe a loculated collection located outside the biliary tree. Kuligowska et al. extended the term biloma to include intrahepatic as well as extrahepatic collections of bile. Bilomas mainly result from iatrogenic, traumatic, or spontaneous rupture of the biliary tree . Although bile leakage into the peritoneal cavity is a known complication of open and laparoscopic cholecystectomy , the hepatic subcapsular biloma is an exceptional complication after cholecystectomy. Some authors attribute this complication to a small biliary perforated radical because of the backpressure associated with the high-pressure irrigation used during choledochoscopy .
High pressure in the proximal biliary ducts, caused by injection of contrast material, is the reported cause of a hepatic subcapsular biloma after ERCP . We think that the possible etiology for the hepatic subcapsular biloma in our patient is a disruption of a small biliary radical near the gallbladder bed during dissection, because the procedure was technically difficult and the anatomy was not well defined. The right upper quadrant abdominal pain is the constant sign in the patient with subcapsular biloma described in the literature, associated sometimes with nausea and vomiting . Our case was unique that the patient presented with respiratory symptoms without any abdominal signs.
Ultrasound is sensitive for diagnosing bilomas, but the diagnosis of this complication is ideally facilitated by the use of Computed tomography , Imaging of the biliary tree should be performed early to determine the location and extent of bile leaks . Hepatic subcapsular biloma can be drained percutaneously with removal of the drainage catheter when the output is minimal -. Our patient and the three other reported cases of bilomas were managed similarly with US guided percutaneous drainage with a good outcome. To conclude a subcapsular biloma is an exceptional complication of cholecystectomy. Early diagnosis and appropriate percutaneous drainage are the key to manage this rarity.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
- De Palma GD, Galloro G, Iuliano G, Puzziello A, Persico F, Masone S, Persico G: Leaks from laparoscopic cholecystectomy. Hepatogastroenterology. 2002, 49: 924.PubMedGoogle Scholar
- Emmanuel Christoforidis Al: A Single Center Experience in Minimally Invasive Treatment of Postcholecystectomy Bile Leak, Complicated With Biloma Formation. J Surg Res. 2007, 141: 171-175. 10.1016/j.jss.2006.07.012.View ArticlePubMedGoogle Scholar
- Soon SY, Wakefield C, Nixon SJ: Bile leak after laparoscopic cholecystectomy. Br J Surg. 2000, 87: 56-57.Google Scholar
- Braithwaite BM, Cabanilla LT, Lilly M: Hepatic subcapsular biloma: a rare complication of laparoscopic cholecystectomy and common bile duct exploration. Curr Surg. 2003, 60: 196-198. 10.1016/S0149-7944(02)00738-9.View ArticlePubMedGoogle Scholar
- Dupas JL, Mancheron H, Sevenet F, Delamarre J, Delcenserie R, Capron JP: Hepatic subcapsular biloma. An unusual complication of endoscopic retrograde cholangiopancreatography. Gastroenterology. 1988, 94: 1225-1227.PubMedGoogle Scholar
- Hartle RJ, McGarrity TJ, Conter RL: Treatment of a giant biloma and bile leak by ERCP stent placement. Am J Gastroenterol. 1993, 88: 2117.PubMedGoogle Scholar
- McLindon JP, England RE, Martin DF: Causes, clinical features and non-operative management of bile leaks. Eur Radiol. 1998, 8: 1602-10.1007/s003300050595.View ArticlePubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.