Bilateral Hepatic Subcapsular Biloma: A Rare Case Report

[摘要] Background: Biloma is loculated collection of bile that may develop due to iatrogenic causes, trauma­tically or spontaneously with biliary tree disruption. Hepatic bilateral subcapsular bi­loma is a rare complication of laparoscopic cho­lecys­­tec­tomy and an even more scarce when it occurs spontaneously. Case Presentation: A 65 years old man came to our hospital with abdominal pain and en-larged abdomen. Six weeks earlier he under­went laparoscopic cholecys­tectomy in a private hospi­tal, because of stone in the gall bladder and cho­lecys­titis. The physical examina­tion obtained no icteric and distended abdomen with pain on palpation. Laboratory findings were within nor­mal limit with negative viral infection markers. Abdominal ultrasonography revealed chronic liver disease with giant liver cyst and ascites. Contrast abdominal multi-slice computed mono­graphy (MSCT) demonstrated bila­teral hepatic sub­capsular biloma. Laparatomy and drainage were then performed and he was discharged from the hospital several days later in good condition. Discussion : Biloma was first introduced by Gould and Patel in 1979. The incidence of past laparoscopic cholecystectomy biloma is very low, between 0.6% and 1.5%. Early accurate diagnosis is very important to determine the proper mana­gement. In our case, the biloma was found by using USG and MSCT.  Usually it presents with right upper quadrant or epi­gastric pain, abdo­minal distention, fever and leukocytosis, but our patient did not have either fever or leukocytosis. Actua­lly the first treatment choice is percuta­neous catheter drai­nage but in our case laparo­tomy drainage was performed because of sub­capsular, biloma in both right and left hepatic lobes. Conclusion: Bilateral hepatic subcapsular bilo­ma is a rare case. One of its diagnostic tools is MSCT. Biloma drainage is the first choice of treatment.

[学科分类] 眼科学

[关键词] Biloma;post laparoscopic cho­lecys­­­tec­tomy;drainage