Sonographic assessment of a suspected biloma: A case report and review of the literature

Spontaneous Biloma Secondary to Choledocholithiasis

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.

A Case of Candidal Infection of Large Biloma After CT-Guided Liver Biopsy Confirming Autoimmune Hepatitis

Bilomas are unexpected post-procedural complications of cholecystectomies, hepatic resections, endoscopic retrograde cholangiopancreatography, and-rarely-liver biopsies. While uncommon, this should remain high on the differential in a patient presenting with sudden postop sepsis even in the absence of significant liver injury. Diagnosis involves coordination between interventional radiology, gastroenterology, and internal medicine. This involves a precise clinical history, invasive radiological techniques, and advanced interventional endoscopic solutions for diagnosis and treatment. This is a case of a biloma that occurred as a consequence of a post-hepatic biopsy and resulted in fungal infection, rather than its more common bacterial counterpart. Due to the unusual circumstances, a more circuitous route to the correct diagnosis and treatment was undertaken.

Spontaneous Biloma Resulting from Intrahepatic Bile Duct Perforation Coexisting with Intrahepatic Cholelithiasis and Cholangiocarcinoma: A Case Report and Literature Review

Patient: Female, 74-year-old

Final Diagnosis: Biloma

Symptoms: Epigastralgia • fever • nausea

Medication: —

Clinical Procedure: —

Specialty: Surgery

Sonographic Detection of a Urinoma/Biloma Combination

Urinoma formation is usually a consequence of trauma to the urinary collecting system. It is a collection of urine that is outside of the kidneys, ureters, or bladder. Similarly, a collection of bile outside of the biliary system is a biloma. Diagnosis of these is possible with a combination of imaging techniques such as sonography and computed tomography. A case is presented of a combination urinoma/biloma that formed after penetrating trauma to the superior pole of the right kidney and lower segment of the right liver lobe. Computed tomography was used to diagnose the pathology, and sonography was used to further characterize the lesion and place the drain that was used as treatment. Use of both of these modalities allowed the patient to receive a quick diagnosis and appropriate intervention.

Treatment of a huge biloma complicating curative radiofrequency ablation of hepatocellular carcinoma: a case report

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.

A Rare Case Report of Biloma After Cholecystectomy

Biloma is an encapsulated collection of bile outside or inside the biliary system within the abdominal cavity. It is a rare condition with an incidence of 0.3%-2%. The most common cause of spontaneous biloma is choledocholithiasis, and other causes include abdominal trauma and surgery, bile duct tumors, liver infarction, percutaneous catheter drainage, transhepatic cholangiogram and endoscopic retrograde cholangiopancreatography (ERCP) but the exact cause is yet to be discovered. We herein present a case report of biloma as a complication of laparoscopic cholecystectomy. A 58-year-old male presented to our hospital emergency room with complaints of fever, nausea, vomiting, and pain in the right upper quadrant after six weeks of laparoscopic cholecystectomy for cholecystitis. He was diagnosed with computed tomography (CT) scan quickly, and he has treated with pigtail catheter percutaneous drainage. On a follow-up visit, after four weeks, his abdominal pain had improved and white blood count was also reduced to baseline.

Hepatic artery resistive index as surrogate marker for fibrosis progression in NAFLD patients: A clinical perspective

Ultrasound (US) can reveal the presence of steatosis in non-alcoholic fatty liver disease (NAFLD), but its diagnostic accuracy to reveal signs of fibrosis is low except in advanced stages of disease (e.g. cirrhosis). Current guidelines suggest the use of clinical algorithms, such as the NAFLD fibrosis score, and elastography to predict the progression of fibrosis, and the integration of elastography improves the detection accuracy of liver stiffness. However, there is a lack of evidence about the correlation between clinical algorithms and conventional US, and elastography is limited by the relative low diffusion, necessity of training, and loss of diagnostic accuracy in patients with high body mass index (BMI), waist circumference, or increased thickness of parietal walls, with consequent significant rates of failure of measurement of liver stiffness. Recently, the measurement of hepatic artery resistive index (HARI) has demonstrated a significant positive correlation with fibrosis degree, as measured with NAFLD fibrosis score, suggesting that the fibrous tissue accumulation may result in increased arterial rigidity and, therefore, in a rise of resistance to flow, and that the different tissue composition of the liver (adipose versus fibrous) can influence HARI differently. These issues should be further investigated because some aspects are still unknown. The limited data currently justify the need of larger, prospective studies aimed at assessing whether HARI correlates with elastography results. In view of their effect on weight loss, serum lipid concentration, and hepatic arterial flow hemodynamics, it could be interesting to evaluate if lifestyle and diet changes can influence significantly HARI values in NAFLD patients.

Case Report: Biloma gastrostomy after failed sonogram-guided percutaneous aspiration, pigtail catheter insertion and surgical drainage

Bilomas are rare abnormal extrabiliary accumulation of bile.  This can be either intrahepatic or extrahepatic following traumatic or spontaneous rupture of the biliary tree. The commonest causes of biloma are surgery, percutaneous transhepatic cholangiography, percutaneous transhepatic biliary drainage, transcatheter arterial embolization and abdominal trauma. We report here a 15 year old patient whom we followed for over 10 years. His chief complaints were right hypochondriac pain, loss of appetite and vomiting. Initial clinical presentation, sonographic as well as laboratory findings suggested a liver abscess, which was drained, but the definitive diagnosis of biloma was entertained after sonographically guided percutaneous aspirations and percutaneous transhepatic cholangiography 7 years later. We also discuss the role of imaging and surgical challenges encountered that culminated into bilomo-gastrostomy. The patient is now enjoying a peaceful life.

Diffusion-weighted magnetic resonance imaging for non-neoplastic conditions in the hepatobiliary and pancreatic regions: pearls and potential pitfalls in imaging interpretation

Potentially, diffusion-weighted magnetic resonance imaging (DWI) can assess the functional information on concerning the status of tissue cellularity, because increased cellularity is associated with impeded diffusion. DWI in the hepatobiliary and pancreatic regions has demonstrated the usefulness to detect malignant lesions and differentiate them from benign lesions. However, it has been shown more recently that there is some overlap in ADC values for benign and malignant neoplasms. Moreover, some non-neoplastic lesions in the hepatobiliary and pancreatic regions exhibit restricted diffusion on DWI, because of pus, inflammation, or high cellularity. Focal eosinophilic liver disease, hepatic inflammatory myofibroblastic tumor, granulomatous liver disease, acute cholecystitis, xanthogranulomatous cholecystitis, focal pancreatitis, or autoimmune pancreatitis frequently exhibit restricted diffusion on DWI, which may be confused with malignancy in the hepatobiliary and pancreatic regions. Thus, DWI should not be interpreted in isolation, but in conjunction with other conventional images, to avoid the diagnostic pitfalls of DWI. Nevertheless, the presence of diffusion restriction in the non-neoplastic lesions sometimes provides additional information regarding the diagnosis, in problematic patients where conventional images have yielded equivocal findings. DWI may help differentiate hepatic abscess from malignant necrotic tumors, gallbladder empyema from dense bile or sludge in the gallbladder, and pylephlebitis from bland thrombosis in the portal vein. Therefore, knowledge of DWI findings to conventional imaging findings of diffusion-restricted non-neoplastic conditions in the hepatobiliary and pancreatic regions helps establishing a correct diagnosis.

Spontaneous biloma: a case report

A biloma is an encapsulated collection of bile located in the abdomen. It occurs spontaneously or secondary to traumatic or iatrogenic injury to the biliary system. The patient's medical history, symptoms and diagnostic imaging findings suggest the diagnosis, but a definitive diagnosis is provided by drainage and biochemical analysis of the fluid. We report a case of a patient admitted with acute abdominal pain in the right hypochondrium caused by a spontaneous biloma. This is a rare condition, and the reason for the onset was not identified. We discuss the role of the various diagnostic imaging techniques, particularly that of ultrasound.