Spontaneous Biloma Secondary to Choledocholithiasis

Arramón, Marianela; Sciarretta, Martín; Correa, Gustavo Javier; Yantorno, Martín; Redondo, Agustina; Baldoni, Fernando; Tufare, Francisco

doi:10.14309/crj.0000000000000620

Cited by 4 publications

(7 citation statements)

References 12 publications

(31 reference statements)

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“…Choledocholithiasis itself could have played an important role in the event of gallbladder rupture. The presence of gallstones within the common bile duct could increase the intraductal pressure and therefore compromise the more vulnerable parts of the biliary tree [10].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Intrahepatic Gallbladder Rupture and Biloma Mimicking Pulmonary Embolism Following Orthopedic Surgery

Doudakmanis,

Dimeas,

Dimeas

et al. 2023

Cureus

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In this case report, a 75-year-old male with a history of coronary artery disease, type 2 diabetes, hypertension, and benign prostate hypertrophy developed postoperative fever and chest pain following left knee arthroplasty. Upon admission to the emergency department, pulmonary embolism was considered highly probable, and the patient was treated with anticoagulation and antibiotics due to diagnostic uncertainty. However, further investigations revealed a complex condition involving an intraparenchymal gallbladder rupture resulting in a biloma secondary to choledocholithiasis. The patient's history of receiving spinal anesthesia with intrathecal morphine was identified as a potential causative factor to the sphincter of Oddi constriction, leading to increased biliary pressure and gallbladder rupture. This case highlights the importance of having a broad differential diagnosis in postoperative patients, especially when the clinical presentation is atypical. With the diagnosis being confirmed, the patient underwent successful treatment, including biliary stenting, drainage of the biloma, and ultimately cholecystectomy. This case underlines the need for vigilance and a multidisciplinary approach in managing complex postoperative complications, emphasizing that clinical presentations may sometimes deviate significantly from the expected, requiring further investigation and individualized treatment.

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Section: Discussionmentioning

confidence: 99%

“…Rarely, in the absence of the causes mentioned above, spontaneous bilomas may occur. They come as a result of an obstruction in the biliary tree, such as in the case of choledocholithiasis, and a sudden increase in the intrabiliary pressure [10].…”

Section: Introductionmentioning

confidence: 99%

Intrahepatic Gallbladder Rupture and Biloma Mimicking Pulmonary Embolism Following Orthopedic Surgery

Doudakmanis,

Dimeas,

Dimeas

et al. 2023

Cureus

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show abstract

“…The most frequent cause of spontaneous biloma is choledocholithiasis[ 45 ], with the underlying mechanism hypothesized as an increase in intraductal pressure due to stone obstruction. Unfortunately, the clinical presentations of biloma are non-specific, including abdominal pain, fever, nausea, vomiting, and jaundice[ 46 ].…”

Section: Discussionmentioning

confidence: 99%

Phlegmonous gastritis after biloma drainage: A case report and review of the literature

Yang¹,

Kuo²,

Kang³

2022

World J Clin Cases

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BACKGROUND Phlegmonous gastritis (PG) is a rare bacterial infection of the gastric submucosa and is related to septicemia, direct gastric mucosal injury, or the direct influence of infection or inflammation in neighboring organs. Here, we present a patient who had spontaneous biloma caused by choledocholithiasis and then PG resulting from bile leakage after biloma drainage. CASE SUMMARY A 79-year-old man with a medical history of hypertension had persistent diffuse abdominal pain for 4 d. Physical examination showed stable vital signs, icteric sclera, diffuse abdominal tenderness, and muscle guarding. Laboratory tests showed hyperbilirubinemia and bandemia. Contrast computed tomography (CT) of the abdomen showed a dilated common bile duct and left subphrenic abscess. Left subphrenic abscess drainage revealed bilious fluid, and infected biloma was confirmed. Repeated abdominal CT for persistent epigastralgia after drainage showed gastric wall thickening. Esophagogastroduodenoscopy (EGD) showed an edematous, hyperemic gastric mucosa with poor distensibility. The gastric mucosal culture yielded Enterococcus faecalis . PG was diagnosed based on imaging, EGD findings, and gastric mucosal culture. The patient recovered successfully with antibiotic treatment. CONCLUSION PG should be considered in patients with intraabdominal infection, especially from infected organs adjacent to the stomach.

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“…There has been a reported case in the literature in which a patient developed spontaneous biloma in the setting of choledocholithiasis. Patients showed resolution of bilomas with CT-guided drain of biloma followed by ERCP with sphincterotomy and extraction of biliary stones [5].…”

Section: Discussionmentioning

confidence: 99%

Idiopathic Benign Impulsive Bilomas

Matli

Shepherd

Dhahri

et al. 2021

Cureus

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Biloma" is a collection of bile outside of the biliary tree that could occur postoperatively in patients who undergo laparoscopic cholecystectomy or in patients with blunt trauma to the liver. Spontaneous or impulsive bilomas with no identifiable cause occur rarely. We report a case of a 60-year-old woman with no history of hepatobiliary surgery or trauma, who was admitted for right upper quadrant pain. An abdominal examination revealed tenderness in the right upper quadrant (RUQ). Her alkaline phosphatase level was 2,343 IU/L. Computed tomography of the abdomen and pelvis with contrast showed perihepatic, periduodenal, and right paracolic gutter ascites. The image-guided aspiration of the peritoneal cavity yielded greenish fluid that was determined to be bile. The cytological studies were negative for malignancy and microorganisms. The ultrasound images of the RUQ were negative for cholecystitis and gallstones, and the results of the hepatobiliary nuclear scan study (HIDA) were unremarkable. Magnetic resonance cholangiopancreatography (MRCP) revealed an intact intrahepatic and extrahepatic biliary tree and confirmed the presence of multiple lakes of bile ascites.During the entire hospital stay, the patient remained stable without any unifying diagnosis and she was discharged with a pigtail catheter. A follow-up abdominal CT scan revealed a complete resolution of the bilomas. We consider this as a spontaneous extra-and intrahepatic biloma of unknown etiology and should be in our differentials when a patient presents with right upper quadrant abdominal pain.

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Spontaneous Biloma Secondary to Choledocholithiasis

Cited by 4 publications

References 12 publications

Intrahepatic Gallbladder Rupture and Biloma Mimicking Pulmonary Embolism Following Orthopedic Surgery

Intrahepatic Gallbladder Rupture and Biloma Mimicking Pulmonary Embolism Following Orthopedic Surgery

Phlegmonous gastritis after biloma drainage: A case report and review of the literature

Idiopathic Benign Impulsive Bilomas

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