Bilioma Due to Blunt Abdominal Trauma: A Case Report and Review of Literature

Abstract

Background: Bilioma is a rare abnormal localized collection of bile outside biliary tree due to an injury or biliary leak postoperatively. Case: A 15 years old male presented to us with a complaint of greenish discharge from abdominal scar with generalized abdominal pain. There was supra-umbilical localized bulging and generalized guarding and rigidity since three days. The patient was giving a history of blunt abdominal trauma three months back for which he had undergone laparotomy, but he is not aware of which procedure done. At laparotomy we found a loculated collection of bile measuring 20 x 15 cm. which was drained and its wall sent for histopathological examination. The histopathological report is suggestive of the fibrous wall. Conclusion: Intra-abdominal collection points towards traumatic injury to the biliary system.. The biliary injury is to be thoroughly investigated which had led to the formation of the bilioma. The management depends on whether there is an ongoing bile leak or just an old collection (infected/sterile).

Biloma secondary to blunt liver trauma in a pediatric patient: case report

“…6 The term biloma was first introduced in 1979 by Gould and Patel, and describes a well demarcated collection, encapsulated or not, located outside the bile duct, extending the term by Kuligowska to include intra and extrahepatic bile collections. [12][13][14] The main causes are iatrogenic, traumatic or spontaneous: within the iatrogenic can be after abdominal surgery (it is the most frequent cause, especially in cholecystectomy) or non-surgical (percutaneous drainage, ERCP, transhepatic cholangiography or liver biopsy). [12][13][14] In 1979, Gonsalves reported one case secondary to the use of Prednisolone 5 mg daily for 10 years in a patient with rheumatoid arthriti and another case was reported with the use of steroid therapy for two months due to nephrotic syndrome in a 27year-old patient; spontaneous biloma is very rare, most commonly associated with choledocholithiasis in adults and congenital biliary malformations in pediatric age, being other rare causes bile duct tumors, hepatic and idiopathic infarction.…”

“…[12][13][14] The main causes are iatrogenic, traumatic or spontaneous: within the iatrogenic can be after abdominal surgery (it is the most frequent cause, especially in cholecystectomy) or non-surgical (percutaneous drainage, ERCP, transhepatic cholangiography or liver biopsy). [12][13][14] In 1979, Gonsalves reported one case secondary to the use of Prednisolone 5 mg daily for 10 years in a patient with rheumatoid arthriti and another case was reported with the use of steroid therapy for two months due to nephrotic syndrome in a 27year-old patient; spontaneous biloma is very rare, most commonly associated with choledocholithiasis in adults and congenital biliary malformations in pediatric age, being other rare causes bile duct tumors, hepatic and idiopathic infarction. [12][13][14] Our patient did not have the aforementioned history, so its origin is considered posttraumatic (presented 4 weeks before the appearance of biloma).…”

“…The detergent activity of bile acids has been considered to cause chronic inflammation that promotes adhesion, causing the lobed appearance of the collection. 12 Most collections are located in subhepatic space (mainly) and right subphrenic space, although they may be in the upper left quadrant in up to 40% of cases or be subcapsulated less frequently. 13,14 Although the clinical symptomatology is very unspecific, the most common is that it occurs with pain in the upper right quadrant, abdominal distension and associated with fever, persistent bile drainage or jaundice, agreeing the main symptoms with what is referred to in our case.…”

“…13,14 Although the clinical symptomatology is very unspecific, the most common is that it occurs with pain in the upper right quadrant, abdominal distension and associated with fever, persistent bile drainage or jaundice, agreeing the main symptoms with what is referred to in our case. [12][13][14] The presentation of a biliary leak is very unspecific and an early accurate diagnosis is very difficult; Endoscopic retrograde cholangiopancreatography (ERCP) is the suggested evaluation modality after liver trauma, However it is usually used only when there is an obvious clinical jaundice, not before, which could condition a late treatment and the development of complications such as biloma, infection or intra-abdominal sepsis. 15 In the specific case of bilomas, abdominal ultrasound is the method of first line research, however the contrast tomography allows to define in a precise way its size, nature (unilocular or septate) regional distribution and anatomy in relation to adjacent structures, as well as the underlying cause.…”

“…15 In the specific case of bilomas, abdominal ultrasound is the method of first line research, however the contrast tomography allows to define in a precise way its size, nature (unilocular or septate) regional distribution and anatomy in relation to adjacent structures, as well as the underlying cause. 12,13 Biloma can have different sizes, from a few centimeters to 40 cm, with the largest presenting a maximum of 5700 ml of bile; differential diagnosis should be made with hematomas, seromas, liver abscess, cyst, pseudocyst or lymphocele. [12][13][14] Magnetic cholangioresonance or ERCP are very useful when there is an active or persistent bile leakage, but if this leakage is not continuous it usually hinders the diagnosis.…”