Biloma Secondary to Percutaneous Liver Biopsy Case Report

Abstract

Biloma and biliary leak after percutaneous liver biopsy (PLB) are rare. Previous cases are largely in the setting of transplant, oncology, and cirrhotic patients. Patients can be asymptomatic, peritoneal, or present with obstructive symptoms, including bilirubinemia. A 55-year-old male referred for transaminitis attributed to nonalcoholic fatty liver disease (NAFLD) underwent an ultrasound- (US-) guided PLB. He returned the same day with abdominal pain, normal vitals, a nontender abdomen, and a leukocytosis. He was found to have a subcapsular fluid collection attributed to a hematoma. He underwent observation and was discharged. He presented 4 days later with fever, tachycardia, leukocytosis, and bilirubinemia. CT demonstrated growth of the subcapsular fluid collection. Percutaneous drainage revealed bilious fluid. He was transferred for endoscopic retrograde cholangiopancreatography (ERCP). A right biliary branch was stented, and he was discharged the following day with antibiotics. US should be utilized for percutaneous biopsies to avoid biliary complications. Typical presentations of biliary complications include abdominal pain and biliary obstruction. The differential diagnosis for perihepatic and subcapsular fluid collections after PLB should include bile. ERCP should be offered for the treatment of larger or symptomatic collections.

Hepatic Subcapsular Biloma: a Rare Complication of Laparoscopic Cholecystectomy

“…The diagnosis of biloma can be made by demonstrating a communication with the biliary tree, as in the present case, or through chemical analysis of the fluid collection [4]. Once recognized, percutaneous drainage of the biloma should be performed and ERCP can be reserved for large or persistent fluid collections, and if a collection is infected, antibiotics should be initiated [6]. We believe that our patient's biloma occurs in relation with disruption of a small biliary radicle near the gallbladder during dissection since there was a communication between the biloma and the gallbladder bed.…”