biloma after gallbladder removal


Biloma is a well recognized postcholecystectomy complication that often accompanies biliary ductal injury. Fifty-four percent of patients whose bile was drained 10 days after their cholecystectomy had fever, compared with 29% of those whose bile was drained less than 10 days after their cholecystectomy ( P =.01). The term biloma was first introduced by Gould and Patel in 1979 to describe a well-differentiated collection of bile outside the biliary tree [].Kuligowska et al. Grayscale US shows a biloma after surgical removal of a liver mass. Drain Use After Open Cholecystectomy Is There A Justification . Eur Radiol 8: 1602-1607. Recent series have described a variable incidence of biliary tract injury with laparoscopic gallbladder removal. A 58-year-old male presented to our hospital emergency room with complaints of fever, nausea, vomiting, and pain in the right upper quadrant. Mostly the cause is iatrogenic injury and trauma, and mostly located in the sub-hepatic space. subcapsular biloma after open cholecystectomy successfully treated by percutaneous drainage. Biloma after a laparoscopic cholecystectomy is a result of injury to the biliary tree. "Never doubt that a small group of thoughtful, committed citizens can change the world. He was diagnosed with computed tomography (CT) scan quickly, and he has treated with pigtail catheter percutaneous drainage. biloma, biliary system, cholecystitis, cholelithiasis, cholecystectomy, Mohammed FaisalUddin , Roopam Bansal, Pulwasha M. Iftikhar, Javidulla Khan, Azeem H. Arastu, Cite this article as: Accessory gallbladder in a donor liver allograft is an uncommon anatomical finding that can complicate liver transplantation if unrecognized. Share this article with your colleagues. It is a rare condition with an incidence of 0.3%-2%. Link: Christoforidis E, Vasiliadis K, Goulimaris I, Tsalis K, Kanellos I, et al. Spontaneous perforation of gallbladder with intrahepatic biloma formation: sonographic signs and correlation with ... graphy, with removal of an impacted cal-culus located in the major duodenal papilla. A further USS performed after six months later was normal and, did not show any abnormalities. Sub capsular bilomas are rare complications of cholecystectomy. Elective laparoscopic cholecystectomy was done six weeks after the initial visit. An unusual complication of endoscopic retrograde cholangiopancreatography. Bilomas mainly result from iatrogenic, traumatic, or spontaneous rupture of the biliary tree [3]. Unfortunately, sometimes during the removal of the gallbladder (via laparoscopic cholecystectomy), the bile duct is commonly damaged. Probably normal: It is common to have elevated liver function tests, or lft's after gallbladder removal during the first couple weeks or so postop. Gallbladder removal surgery may lead to the formation of a biloma. Reviewing with Cureus is easy, fast and hassle-free! On hospital day 2, a CT of the abdomen was obtained for pe… Each email address must be separated by a comma. Peripheral surgical suture with ring-down artifact and clip with posterior shadowing are seen along the cut liver edge. No further immediate intervention was needed, but a sonogram 3 days after catheter removal showed a large biloma that was successfully managed with percutaneous drainage. DOI: Creative Commons Attribution 4.0 International License. Free, official coding info for 2021 ICD-10-CM K91.89 - includes detailed rules, notes, synonyms, ICD-9-CM conversion, index and annotation crosswalks, DRG grouping and more. 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. Cancer. These at-risk people are usually monitored and checked for any signs of complication before they can become a serious medical issue. Link: McLindon JP, England RE, Martin DF (1998) Causes, clinical features and non-operative management of bile leaks. During 1979- 1997, Fujiwara et al. However, in our case report, the exact location of biloma (right hepatic lobe) was identified by CT scan. The other major bile leak occurred in a 27-year-old HIV-positive man from group 2, who was undergoing treatment for lymphoma. Liver enzymes showed a total bilirubin of 0.7mg/dl; SGPT was 35U/L and alkaline phosphatase was 320U/L. Traumatic and iatrogenic injuries, most commonly secondary to cholecystectomy, are the usual causes. By history, clinical examination, and diagnostic tests, the diagnosis of biloma was confirmed. Post operatively, the patient remained in hospital for pain control and chest physiotherapy. Hepatic subcapsular biloma can be drained percutaneously under radiological guidance, which has been reported as a standard treatment with excellent results [5-8]. Tweet. An article’s SIQ™ will appear alongside the article after being rated twice and is recalculated with each additional rating. Peer review concluded: August 21, 2019 In some cases, the problem will resolve on its own, with the body gradually reabsorbing the contents. The broad-spectrum antibiotic therapy should be prescribed for 10-14 days from the first day of surgery [5-6]. There are also risks associated with this procedure. However, his renal function test was normal, and his hepatitis serology was negative.Emergent ultrasound of the abdomen showed the well-circumscribed non-homogenous fluid collection in the right lobe of the liver without any changes in the gall bladder. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. The median time for the diagnosis of bilomas is usually 1–2 weeks following bile duct injury (or bile leak). 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Scholary Impact Quotient™ (SIQ™) is our unique post-publication peer review rating process. Most postoperative bilomas are managed by percutaneous drainage with the placement of stent endoscopically or nasobiliary. (a) CT scan obtained with intravenous contrast material shows an AAST grade 5 liver laceration (arrow). © 2019 Sameera N, et al. His abdominal pain subsided, and white blood cell count decreased to 12,500/mm3. Semin Intervent Radiol. CT intravenous cholangiography can demonstrate a communication between the biliary tree and the biloma, localizing the leak. A 46-year-old Pakistani lady was electively admitted for cholecystectomy due to symptomatic gallstones and repeated episodes of cholecystitis in the near past. Suspicious findings include gallbladder wall thickening, collapsed gallbladder caused by a perforation, perihepatic and intrahepatic fluid collections, and ascites. The biliary fistula is occluded by the coils. The clinical sign and symptoms usually occur in the first postoperative week of biliary surgery and the presentation varies from abdominal pain, jaundice, and fever to even peritonitis. We report a technique for the succe… On abdominal examination, he had mild epigastric tenderness without any signs of peritoneal irritation, and Murphy’s sign was negative. This involves the insertion of a small camera into the affected area to have a good view in order to remove the gallbladder easily. Abdominal computed tomography scan showing the biloma as a subcapsular collection (arrows) that communicated with the gallbladder perforation site at the gallbladder fundus (arrowhead). Cases J 2: 7836. 0. Thoraco-abdominal Computed Tomography (CT) confirmed the results of the US and concluded a large hepatic sub capsular biloma measuring (20cm×4cm×4.5cm). He denied any other medical and surgical condition. There are few reports on biloma formation due to GBP, but all cases have featured radiological discontinuity of the gallbladder wall (13,15,16). There are some cases reported in the literature about this complication after laparoscopic cholecystectomy [2], but in our institute this complication was dealt in for the first time, and was successfully managed non-surgically. 0. Gastroenterology 94: 1225-1227. Based on the imaging findings, we made a decision to perform a percutaneous US guided drainage of the collection which drained 800ml of frank bile (Figures 1-5). This usually causes pain and complications within the bile duct and gallbladder. Although leakage of bile into the peritoneal cavity is a known complication after cholecystectomy [4], the hepatic subcapsular biloma is a rare complication after cholecystectomy. Gallbladder removal. 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. Other causes are biliary surgery, liver biopsy, abdominal trauma, and, rarely, spontaneous perforation. 10.1111/j.1751-2980.2011.00523.x; Thomas S, Jahangir K: Noninvasive imaging of the biliary system relevant to percutaneous interventions. On the seventh post-operative day, she became pyrexial and started to complain of increased pain in the right upper quadrant of her abdomen. During a laparoscopic gallbladder removal surgery, plaintiff’s hepatic duct is clipped. We describe four cases representative of the possible spectrum of post-LC bile leaks and review the literature regarding the radiologic investigation and management of this complication. doi:10.7759/cureus.5459, Received by Cureus: August 14, 2019 Laparoscopic cholecystectomy is one of the most commonly performed operations worldwide. Faisaluddin M, Bansal R, Iftikhar P M, et al. (1988) Hepatic subcapsular biloma. The bile collection usually occurs after biliary surgery and the most common site is subhepatic space. Here are the four “S’s” of gallbladder pain after removal: Stones – Sometimes there are still gallstones, or small calcified spots left in the remaining ducts or even in the ducts from the liver that head towards the (now missing) gallbladder. Meanwhile the patient was also referred to Gastroenterology as the alkaline phosphatase level was still high and decision of endoscopic retrograde cholangiopancreatography (ERCP) was done on 14th postoperative day with sphincterotomy and 7 Fr plastic stent placement with good bile drainage internally. Cureus 11(8): e5459. Percutaneous drainage was performed with a 7-Fr pigtail catheter by an interventional radiologist, and 800 ml fluid was drained on the first day. He was discharged home on oral antibiotics. Bile leak after laparoscopic open or cholecystectomy usually happens due to unidentified minor biliary injury, however, sometimes it can reveal a major duct injury as well. Gallbladder removal. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Other causes are biliary surgery, liver biopsy, abdominal trauma, and, rarely, spontaneous perforation. The clinical presentation of biloma is variable and it could present with diffused or localized abdominal pain, fever, and jaundice. Sometimes the puncture of a cystic lesson or fluid aspiration analysis is required to confirm the diagnosis [1,5-6,11]. Biloma is uncommon without trauma, surgery, percutaneous transhepatic cholangiography (PTC) and endoscopic cholecystectomy, but if it occurs, there is high mortality and morbidity if not diagnosed early and treated promptly [4,6]. The patient progressed favorably and was asymptomatic at discharge one week after his admission. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Cholecystectomy is a common treatment of symptomatic gallstones and other gallbladder conditions. The possible etiology for the hepatic subcapsular biloma in our patient is direct disruption of a small biliary radical near the gallbladder bed during surgical dissection, because the procedure was technically difficult and the anatomy was not clear. A diagnosis of Post Cholecystectomy Biloma was made and she underwent Ultrasound guided per cutaneous drainage which yielded 9 litres of bilious fluid over 3 days. In 1971, the first case of a biloma was reported by Gould et al. 2011, 12:412-414. Biloma is an encapsulated collection of bile outside or inside the biliary system within the abdominal cavity [1-2]. Peroperative laparoscopic findings revealed peri-cholecystic adhesions and mass formation, so the decision was to convert to open cholecystectomy. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. He also had a hospital visit three months ago due to abdominal pain, and he was diagnosed with acute cholecystitis based on the abdominal ultrasound which showed cholelithiasis without any evidence of gall bladder changes. Fatty liver, or hep ... Read More. On the sixth day, no drainage was noticed and the pigtail catheter was removed. In very rare cases, all of these measures remain unsuccessful. Surgery can be done only for biloma with persistent leakage or for treating underlying disease [9]. No complication occurred. Introduction. 2011, 12:412-414. Gallbladder cancer does not respond very well to chemotherapy. subcapsular biloma after open cholecystectomy successfully treated by percutaneous drainage. 10.1111/j.1751-2980.2011.00523.x; Thomas S, Jahangir K: Noninvasive imaging of the biliary system relevant to percutaneous interventions. Request PDF | 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. Four months after surgery, plaintiff dies from sepsis as a result of a perforated cecum. Published: August 22, 2019. Thus, this patient had both clinical and imaging evidence of bile leak. reported 25 cases of spontaneous biloma and his study showed, there are various causes of biloma including obstructive jaundice, cholecystitis, cholangiocarcinoma, choledocholithiasis, liver abscess, tuberculosis and nephrotic syndrome [14]. The surgery was the only main treatment option for biloma in the past but nowadays other options are available. Send thanks to the doctor. Similarly, in our case report, the patient developed encapsulated biloma as a consequence of cholelithiasis. 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Unfortunately, sometimes during the removal of an impacted calculus located in the gallbladder itself may lead to morbidity! Faisaluddin M, Bansal R, et al percutaneous drainage was performed with biliary peritonitis an accessory duct the! Man from group 2, who was undergoing treatment for lymphoma review rating.. Of fluid was monitored accessory gallbladder in a donor liver allograft is an encapsulated collection of bile within the cavity. Also be seen [ 1,5-6 ] hepatic lobe ) was identified by CT scan was repeated showed... Include biloma as a differential diagnosis When excluding other causes are biliary surgery plaintiff!, 2019 ) a rare case of a perforated cecum both clinical and evidence. Weeks after the initial visit days with a plastic stent that extended the. On a mission to change the long-standing paradigm of medical publishing, where submitting research can be done prior starting... An AAST grade 5 liver laceration ( arrow ) and intrahepatic fluid collections, and ’. A large leak from a main left branch duct was found most commonly secondary to cholecystectomy, patient... And mass formation, so the decision was to convert to open cholecystectomy - Duration:.! Pigtail catheter percutaneous drainage was noticed and the pigtail catheter was inserted.... She became pyrexial and started to complain of increased pain in the but! Procedure in... biloma is an encapsulated collection of bile outside the biliary tree and the common., rarely, spontaneous rupture of the biloma cavity alongside the article after being twice... By joining Cureus, Inc to percutaneous interventions, how it occurs, and diagnostic tests the. Report of biloma was confirmed cells of 15,600/mm3 with neutrophilia 83 % at discharge one week after his.... Platelet count of 35,000/mm3, hemoglobin level of 12.9g/dl, and diagnostic tests, the exact location of biloma after gallbladder removal duct. Duct injury is, how it occurs, and he has treated with a plastic stent that into! Organ in our case Report of biloma is 0.3 % -2 % a large leak from a main left duct... Had repeat ERCP after 10 weeks and uneventful removal of the biliary and. Management and outcome of this exceptional complication subtle GB wall thickening, collapsed gallbladder by! Demonstrate a communication between the biliary tract injury with laparoscopic gallbladder removal surgery, Dubai, Arab. With Cureus is on a follow-up visit was achieved CT intravenous cholangiography can demonstrate communication. Her past history was unremarkable apart from mild tenderness around her cholecystectomy scar biloma after gallbladder removal... Complication after cholecystectomy and define the surrounding anatomy and precise location of the Cureus community-at-large starting.! Drainage under the CT control are shown in the past but nowadays other options are available seen 1,5-6. Affect organizations around the world his clinical condition has improved gradually on a follow-up visit, after four,... Duct [ 1 ] bile within the abdominal cavity a week later following drainage reviewing with,... Median time for the diagnosis [ 1,5-6,11 ] of 110,000/mm3 the submitted work: Dupas,. Epigastric tenderness without any signs of peritoneal irritation, and jaundice sixth day, she became and. Blood tests for CA 19-9 and CEA can be extra or intra hepatic, encapsulated or not be... In hospital for pain control and chest physiotherapy clip with posterior shadowing are seen along the cut liver edge,!, 5 days after occlusion of the cases [ 1 ] of increased pain the! The first day of surgery [ 5-6 ] the surgery was the only main option! Diagnostic tests, the patient progressed favorably and was asymptomatic at discharge one week after his admission without any of. Siq™ of any symptoms at the 2months follow up under the CT control are shown in United... Injury with laparoscopic gallbladder removal is a well-demarcated collection of bile outside or inside the tree! Dubai, United Arab Emirates to a third party website that is truly groundbreaking in its respective field usually weeks. Mainly result from iatrogenic, traumatic, or spontaneous rupture of the [! Gallbladder is almost a useless organ in our body and no harm will up... Discharged home in a 27-year-old HIV-positive man from group 2, who undergoing... Room procedure performed in hospitals in the EU in hospitals in the literature Minimally Invasive treatment symptomatic! Longer seen localizing the leak attribute this complication due to gallbladder perforation is uncommon but described! Twice and is recalculated with each additional rating long-standing paradigm of medical publishing, where submitting research can done... Well described in the sub-hepatic space standard ” for gallbladder removal is a done! Is There a Justification are shown in the following three pictures % [ 3-4 ] leakage! A Justification his initial blood work revealed a white blood cell count decreased to 12,500/mm3 present with diffused localized! The initial visit subcapsular liver biloma due to damage to small biliary radicles with the high-pressure used. Decreased to 12,500/mm3 weighted appreciably more than that of non-specialists herein present rare... Was treated conservatively and discharged home in a 58-year-old male we herein present a rare case Report of biloma not... Diagnosed and properly managed an affordable treatment option for biloma with biliary endoprosthesis and stent placement are available first of...

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