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Idiopathic Benign Impulsive Bilomas.

Venkata Vinod Kumar Matli1, Zachary Shepherd1, Amina Dhahri2

  • 1Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA.

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Summary

A rare spontaneous biloma, a bile collection outside the biliary tree, occurred in a woman without prior surgery or trauma. This case highlights spontaneous biloma as a differential diagnosis for right upper quadrant pain.

Keywords:
biliary ascitesbilomacystic duct injuryimpulsive bilomalaparoscopic cholecystectomy complicationmultiple bilomasperihepatic ascitesspontaneous bile leak

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Area of Science:

  • Gastroenterology and Hepatology
  • Diagnostic Imaging

Background:

  • Bilomas, collections of bile outside the biliary tree, typically arise postoperatively after laparoscopic cholecystectomy or from liver trauma.
  • Spontaneous bilomas without a clear cause are uncommon.

Observation:

  • A 60-year-old woman presented with right upper quadrant pain and elevated alkaline phosphatase.
  • Abdominal CT revealed extensive perihepatic, periduodenal, and paracolic ascites.
  • Image-guided aspiration confirmed the ascites to be bile; cytology was negative for malignancy and microorganisms.

Findings:

  • Hepatobiliary scintigraphy (HIDA) and ultrasound were unremarkable for gallstones or cholecystitis.
  • Magnetic resonance cholangiopancreatography (MRCP) showed an intact biliary tree but confirmed multiple bilomas.
  • The patient was diagnosed with a spontaneous extra- and intrahepatic biloma of unknown etiology.

Implications:

  • This case underscores the importance of considering spontaneous biloma in the differential diagnosis for unexplained right upper quadrant pain.
  • The successful resolution with a pigtail catheter suggests a minimally invasive management approach for select cases.
  • Further research into the etiology of spontaneous bilomas may improve diagnostic and therapeutic strategies.