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Ganipisetti VM, Bollimunta P, Dudiki N. Spontaneous Biloma With a Hepatic Mass. Cureus 2023; 15:e40249. [PMID: 37440803 PMCID: PMC10334684 DOI: 10.7759/cureus.40249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 07/15/2023] Open
Abstract
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.
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Affiliation(s)
| | | | - Natasha Dudiki
- Pulmonary and Critical Care, Indiana University Health Ball Memorial Hospital, Muncie, USA
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2
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Mehmood F, Khalid A, Frager S. Perihepatic Biloma in a Non-cirrhotic Patient After Transjugular Intrahepatic Portosystemic Shunt (TIPS). Cureus 2022; 14:e23399. [PMID: 35481310 PMCID: PMC9033531 DOI: 10.7759/cureus.23399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Biloma is an intrahepatic or extrahepatic collection of bile within the abdominal cavity. It can occur spontaneously, or as a result of trauma to the biliary tree. The clinical presentation can be variable and non-specific. Early diagnosis is crucial given the high mortality rate. Diagnostic modalities include abdominal ultrasound, hepatobiliary scintigraphy, computerized tomography (CT), and magnetic resonance imaging (MRI). Treatment options include interventional radiology (IR)-guided drainage, endoscopic drainage, or surgical drainage with a bile leak repair. We report a case of a middle-aged non-cirrhotic patient who presented with abdominal pain and was noted to have extensive portal vein thrombosis. She underwent transjugular intrahepatic portosystemic shunt (TIPS) with thrombectomy and the hospital course was complicated by elevated liver enzymes and found to have intrahepatic biloma requiring IR-guided drainage.
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Moradi G, Rezaei M, Miratashi Yazdi SA. Spontaneous retroperitoneal bilious collection: A case report. J Taibah Univ Med Sci 2021; 17:619-622. [PMID: 35983456 PMCID: PMC9356351 DOI: 10.1016/j.jtumed.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/26/2021] [Accepted: 11/04/2021] [Indexed: 12/02/2022] Open
Abstract
Biloma refers to the encapsulated accumulation of bile in the abdomen. Bilomas generally occur after bile duct disruption. The clinical case of the present report was a 75 Y/O woman with jaundice, fever, abdominal pain, lethargy, and anorexia who had been admitted to the emergency department. Endoscopic retrograde cholangiopancreatography (ERCP) showed severe diffuse dilation of the common bile duct (CBD) and common hepatic duct (CHD) with filling defects. One stone and some sludge and pus were extracted after balloon swiping. Plastic CBD stent placement was performed. An abdominal ultrasound scan showed a stone in the CBD and fluid collection in the right perirenal space. Under ultrasound guidance, a drainage tube was inserted into the retroperitoneal biloma. A serial ultrasound scan revealed a gradual decrease in the size of the biloma. Perforation of the bile duct, which is characterised by the collection of retroperitoneal fluid, is considered an extremely rare condition that can be fatal. Ultrasonography, computed tomography, and endoscopic retrograde cholangiopancreatography were used for the diagnosis. The treatment includes prevention of leakage and bile drainage.
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Affiliation(s)
- Golnaz Moradi
- Department of Radiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohaddeseh Rezaei
- Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed A. Miratashi Yazdi
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding address: Department of Surgery, School of Medicine, Tehran University of Medical Sciences, Sina Hospital, Hassan Abad Square, Imam Khomeini Avenue, Post Box: 1136746911, Tehran, Iran.
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Abstract
A biloma is a collection of bile located outside the bile duct which occurs as a result of iatrogenic and traumatic injuries. Spontaneous biloma is rare and is associated with choledocholithiasis. Diagnosis is performed using an ultrasound, a computed tomography scan, and a nuclear magnetic resonance scan, and is confirmed by drainage and subsequent biochemical analysis of the fluid sample. The first treatment option is percutaneous drainage, and if not successful, endoscopic biliary drainage should be performed. We report a case of a 46-year-old patient with a spontaneous biloma associated with choledocholithiasis.
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Suzuki K, Hashimoto T, Osugi S, Toyota N, Omagari K, Tamura A. Spontaneous Biloma Resulting from Intrahepatic Bile Duct Perforation Coexisting with Intrahepatic Cholelithiasis and Cholangiocarcinoma: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e926270. [PMID: 33064672 PMCID: PMC7576686 DOI: 10.12659/ajcr.926270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Patient: Female, 74-year-old Final Diagnosis: Biloma Symptoms: Epigastralgia • fever • nausea Medication: — Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
- Keiichi Suzuki
- Department of Surgery, National Hospital Organization Tochigi Medical Center, Utsunomiya, Tochigi, Japan
| | - Takeo Hashimoto
- Department of Surgery, National Hospital Organization Tochigi Medical Center, Utsunomiya, Tochigi, Japan
| | - Syoko Osugi
- Department of Surgery, National Hospital Organization Tochigi Medical Center, Utsunomiya, Tochigi, Japan
| | - Naoyuki Toyota
- Department of Surgery, National Hospital Organization Tochigi Medical Center, Utsunomiya, Tochigi, Japan
| | - Kenshi Omagari
- Department of Surgery, National Hospital Organization Tochigi Medical Center, Utsunomiya, Tochigi, Japan
| | - Akihiko Tamura
- Department of Surgery, National Hospital Organization Tochigi Medical Center, Utsunomiya, Tochigi, Japan
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Yousaf MN, D'Souza RG, Chaudhary F, Ehsan H, Sittambalam C. Biloma: A Rare Manifestation of Spontaneous Bile Leak. Cureus 2020; 12:e8116. [PMID: 32542169 PMCID: PMC7292700 DOI: 10.7759/cureus.8116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
A biloma is an intrahepatic or extrahepatic encapsulated collection of bile outside of the biliary tree and within the abdominal cavity. Hepatobiliary interventions and laparoscopic cholecystectomy are the most common etiologies of biloma followed by abdominal trauma, choledocholithiasis, and biliary dilation secondary to biliary stricture. We report a case of a 91-year-old female who presented to the emergency room with an acute onset of epigastric and right upper quadrant sharp pain for one day that radiated to the back, and was associated with two to three episodes of vomiting. Initial abdominal imaging including CT scan, ultrasound and magnetic resonance cholangiopancreatography (MRCP) of the abdomen and pelvis revealed a distended gallbladder with wall thickening, but without evidence of pancreatitis or gallstones. Hepatobiliary iminodiacetic acid (HIDA) scan findings were consistent with extrahepatic biliary leakage into the peritoneum. A cholangiogram demonstrated a perihepatic biloma. A combined approach using fluoroscopic-guided biloma drainage and endoscopic retrograde cholangiopancreatography (ERCP)-guided biliary stent placement across the site of the biliary leak resulted in the complete resolution of symptoms. Biloma should be included in the differential diagnosis of right upper quadrant abdominal pain. A high index of clinical suspicion is required for early diagnosis and treatment.
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Affiliation(s)
- Muhammad N Yousaf
- Internal Medicine, MedStar Union Memorial Hospital, Baltimore, USA.,Internal Medicine, MedStar Franklin Square Medical Center, Baltimore, USA.,Internal Medicine, MedStar Good Samaritan Hospital, Baltimore, USA.,Section of Digestive Diseases, Yale University School of Medicine, New Haven, USA
| | | | - Fizah Chaudhary
- Internal Medicine, MedStar Union Memorial Hospital, Baltimore, USA
| | - Hamid Ehsan
- Internal Medicine, MedStar Union Memorial Hospital, Baltimore, USA
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AlNaqrani FA. Biloma At The Lesser Sac Post Laparoscopic Cholecystectomy. Int J Gen Med 2019; 12:411-414. [PMID: 31807053 PMCID: PMC6844195 DOI: 10.2147/ijgm.s211600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 09/16/2019] [Indexed: 12/03/2022] Open
Abstract
Biloma after a laparoscopic cholecystectomy is a result of injury to the biliary tree. Most commonly the injury is due to an inadequately secured cystic duct stump, an accessory bile duct which seen in 2% of patients or duct of Luschka. In this case we describe biloma at the lesser sac after laparoscopic cholecystectomy.
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Affiliation(s)
- Faisal Abdullah AlNaqrani
- Surgical Department, Faculty of Medicine, University of Taiba and Ohud General Hospital Madina, Madina, Saudi Arabia
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8
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Wang H, Yan Z, Wang J, Zou Y. Treatment of a huge biloma complicating curative radiofrequency ablation of hepatocellular carcinoma: a case report. J Int Med Res 2019; 47:5337-5342. [PMID: 31526172 PMCID: PMC6997779 DOI: 10.1177/0300060519872585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Development of a huge intrahepatic biloma after radiofrequency ablation (RFA) is a rare complication. We report a patient with hepatocellular carcinoma (HCC) who had been treated by RFA and was complicated by a huge biloma. The biloma was cured by percutaneous catheter drainage and endoscopic retrograde cholangiopancreatography. A plastic stent was placed from the duodenal ampulla to the common bile duct to lower the pressure. The catheter and the stent were removed within 1 month after the biloma had disappeared. There was no recurrence of the biloma and HCC lesions with a follow-up time of 2 years. The present case is one of the best reported outcomes after development of a huge biloma.
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Affiliation(s)
- Haochen Wang
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Ziguang Yan
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Jian Wang
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Yinghua Zou
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
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Idriss AM, Tfeil Y, Baba JS, Abdallahi AM, Bezeid A. Non postoperative biloma in Mauritania: case report and literature review. Pan Afr Med J 2019; 31:237. [PMID: 31447994 PMCID: PMC6691282 DOI: 10.11604/pamj.2018.31.237.17607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 12/10/2018] [Indexed: 11/11/2022] Open
Abstract
Biloma is used to describe abnormal accumulation of bile outside biliary tract. It is a very rare condition with extrahepatic diffused or encapsulated collection of bile, mostly post-operative or post traumatic. A 72-year-old woman was referred to our hospital with acute abdominal pain located in right upper quadrant. Clinical examination suspected abdominal collection. Imagery (ultrasound and computed tomography scan) demonstrated a large well-defined intra-abdominal collection. Percutaneous ultrasound guided drainage of abdominal collection revealed a bile fluid. Drain was removed a week later and complete resolution of symptoms was obtained in two weeks. Even in the absence of specific diagnostic indications, radiological images may play a key role in the evaluation of suspected biloma in patients with appropriate medical history and clinical characteristics.
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Affiliation(s)
- Ahmedou Moulaye Idriss
- Department of Surgical Specialties, Faculty of Medicine, Nouakchott Al Aasriya University, Mauritania
| | - Yahya Tfeil
- Department of Surgical Specialties, Faculty of Medicine, Nouakchott Al Aasriya University, Mauritania
| | - Jiddou Sidi Baba
- Department of Surgical Specialties, Faculty of Medicine, Nouakchott Al Aasriya University, Mauritania
| | | | - Ahmed Bezeid
- National Center Hospital, Nouakchott, Mauritania
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Blake-Siemsen JC, Kortright-Farías M. [Spontaneous retroperitoneal biloma: A case report]. CIR CIR 2016; 85:552-556. [PMID: 27837905 DOI: 10.1016/j.circir.2016.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 09/09/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Non-traumatic spontaneous rupture of the biliary tract and retroperitoneal accumulation (retroperitoneal biloma) is an extremely rare condition. CLINICAL CASE A 57 year-old woman with no known biliary disease, started with intense pain in the right abdomen 30 days prior to consultation. She also had jaundice (4+). The initial hepatobiliary ultrasound reported choledocholithiasis and retroperitoneal fluid collection, which was confused with a peri-renal abscess. Guided puncture was performed and the presence of bile was evident. Dilation of the bile duct was observed in the computed tomography. The patient underwent laparotomy to correct both conditions. CONCLUSION The retroperitoneal biloma, also called choleretroperitoneum, is of multifactorial origin. Clinical presentation is non-specific, with diffuse abdominal distension and pain in all patients. The diagnosis is made based on ultrasonography and computed tomography, and can even be diagnosed intra-operatively. The treatment is based on liquid bile drainage and correction of the leak.
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Affiliation(s)
| | - Marisol Kortright-Farías
- Servicio de Cirugía General y Aparato Digestivo, Hospital Ángeles, Ciudad Juárez, Chihuahua, México
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Copelan A, Bahoura L, Tardy F, Kirsch M, Sokhandon F, Kapoor B. Etiology, Diagnosis, and Management of Bilomas: A Current Update. Tech Vasc Interv Radiol 2015; 18:236-43. [PMID: 26615164 DOI: 10.1053/j.tvir.2015.07.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A biloma is a well-demarcated collection of bile outside the biliary tree. Traumatic and iatrogenic injuries, most commonly secondary to cholecystectomy, are the usual causes. Although bilomas are relatively uncommon, this pathologic entity may lead to significant morbidity and mortality if not promptly diagnosed and properly managed. As clinical signs and symptoms of bilomas are often nonspecific and laboratory values may be unremarkable, imaging modalities including ultrasound, computed tomography, magnetic resonance imaging, and hepatobiliary cholescintigraphy play a crucial role in the diagnosis of this condition. It is paramount that interventional radiologists not only be well versed in the management of bilomas but also be knowledgeable in the diagnosis as well as key imaging findings that dictate the interventional management. The purpose of this article is to review the etiology, pathophysiology, and clinical presentation of bilomas to primarily focus on the relevant multimodal imaging findings and the minimally invasive management options.
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Affiliation(s)
- Alexander Copelan
- Department of Radiology and Diagnostic Imaging, Beaumont Health System, Royal Oak, MI.
| | - Lawrence Bahoura
- Department of Radiology and Diagnostic Imaging, Beaumont Health System, Royal Oak, MI
| | - Frances Tardy
- Department of Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Matthias Kirsch
- Department of Radiology and Diagnostic Imaging, Beaumont Health System, Royal Oak, MI
| | - Farnoosh Sokhandon
- Body Imaging, Department of Radiology and Diagnostic Imaging, Beaumont Health System, Royal Oak, MI
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Tana C, D’Alessandro P, Tartaro A, Tana M, Mezzetti A, Schiavone C. Sonographic assessment of a suspected biloma: A case report and review of the literature. World J Radiol 2013; 5:220-225. [PMID: 23805373 PMCID: PMC3692968 DOI: 10.4329/wjr.v5.i5.220] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 04/11/2013] [Accepted: 05/17/2013] [Indexed: 02/06/2023] Open
Abstract
A biloma is a rare disease characterized by an abnormal intra- or extrahepatic bile collection due to a traumatic or spontaneous rupture of the biliary system. Laboratory findings are nonspecific. The diagnosis is usually suspected on the basis of a typical history (right upper quadrant abdominal pain, chills, fever and recent abdominal trauma or surgery) and is confirmed by detection of typical radiologic features. We report the case of a patient with a history of previous cholecystectomy for lithiasis who presented with clinical symptoms and laboratory data suggestive of acute pancreatitis. Imaging studies also revealed the presence of a chronic and asymptomatic biloma, which could be mistaken for a pseudocyst. The atypical location and ultrasound findings suggested an alternative diagnosis. We therefore reviewed the known literature for bilomas, focusing on the role of ultrasonography, which can reveal some typical aspects, such as location and imaging features. We conclude that ultrasound plays a key role in the assessment of a suspected biloma in patients with appropriate history and clinical features and provides valuable diagnostic clues even in the absence of these.
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Kaplan M. A case report of an ampullary tumor presenting with spontaneous perforation of an aberrant bile duct and treated with total laparoscopic pancreaticoduodenectomy. World J Surg Oncol 2012; 10:142. [PMID: 22788965 PMCID: PMC3506572 DOI: 10.1186/1477-7819-10-142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 06/25/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This case report discusses a patient who presented with bile peritonitis due to spontaneous perforation of an aberrant bile duct that originated in the triangular ligament of the liver. It was associated with an ampullary tumor and treated with total laparoscopic pancreaticoduodenectomy (TLPD). CASE REPORT A 58-year-old male patient was admitted to the emergency department of Medical Park Gaziantep Hospital in September 2009 with acute abdominal findings. He underwent an urgent laparoscopy, and, interestingly, bile peritonitis due to the rupture of an aberrant bile duct in the triangular ligament was noted. After laparoscopic treatment of the acute conditions, the follow-up examinations of the patient showed the finding of obstructive jaundice. Endoscopic retrograde cholangio-pancreatography revealed a 1-cm polypoid mass located at the ampulla of Vater (duodenal papilla) with possible extension to the ampullary sphincter. A stent was inserted for temporary biliary drainage, and subsequent endoscopic biopsy showed the pathological finding of adenocarcinoma.After waiting for a 1-month period for the peritonitis to heal, the patient underwent pylorus-preserving TLPD and was discharged without any major complications on postoperative day 7. CONCLUSION In patients with bile peritonitis, it should be considered that the localization of the perforation may be in an aberrant bile duct localized at the triangular ligament and the etiology may be associated with an obstructing periampullary tumor. Laparoscopic pancreaticoduodenectomy is a feasible operative procedure in carefully selected patients. This technique can achieve adequate margins and follows oncological principles. Randomized comparative studies are needed to establish the superiority of minimally invasive surgery over traditional open surgery.
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Affiliation(s)
- Mehmet Kaplan
- Department of General Surgery, Medical Park Gaziantep Hospital, Gaziantep, Turkey.
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Gössling PAM, Alves GRT, Silva RVDA, Corrêa JRM, Marques HF, Haygert CJP. Bilioma espontâneo: relato de caso e revisão da literatura. Radiol Bras 2012. [DOI: 10.1590/s0100-39842012000100013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Bilioma é qualquer coleção de bile fora das vias biliares. Geralmente, resulta de complicações cirúrgicas e trauma abdominal. A ocorrência espontânea é rara, ocasionalmente associada a coledocolitíase. Relata-se um caso de bilioma espontâneo, cujo diagnóstico foi confirmado radiologicamente. À laparotomia, observou-se bilioma retroperitoneal. A colangiografia transoperatória não evidenciou fístula. Após drenagem, o paciente teve boa evolução e alta hospitalar.
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Cong WM, Dong H, Tan L, Sun XX, Wu MC. Surgicopathological classification of hepatic space-occupying lesions: A single-center experience with literature review. World J Gastroenterol 2011; 17:2372-8. [PMID: 21633636 PMCID: PMC3103789 DOI: 10.3748/wjg.v17.i19.2372] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 02/26/2011] [Accepted: 03/05/2011] [Indexed: 02/06/2023] Open
Abstract
Accompanying rapid developments in hepatic surgery, the number of surgeries and identifications of histological types of primary hepatic space-occupying lesions (PHSOLs) have increased dramatically. This has led to many changes in the surgicopathological spectrum of PHSOLs, and has contributed to a theoretical basis for modern hepatic surgery and oncological pathology. Between 1982 and 2009 at the Eastern Hepatobiliary Surgery Hospital (EHBH) in Shanghai, 31 901 patients underwent surgery and were diagnosed as having a PHSOL. In this paper, we present an analysis of the PHSOL cases at the EHBH for this time period, along with results from a systematic literature review. We describe a surgicopathological spectrum comprising more than 100 types of PHSOLs that can be stratified into three types: tumor-like, benign, and malignant. We also stratified the PHSOLs into six subtypes derived from hepatocytes; cholangiocytes; vascular, lymphoid and hemopoietic tissues; muscular, fibrous and adipose tissues; neural and neuroendocrine tissues; and miscellaneous tissues. The present study provides a new classification system that can be used as a current reference for clinicians and pathologists to make correct diagnoses and differential diagnoses among various PHSOLs.
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