CASE REPORT
BILOMA AFTER SUBTOTAL CHOLECYSTECTOMY-A RARE BUT EXPECTED COMPLICATION

UDK: 616.366-089.87-06:616.366-008.8-003.2

www.doi.org/10.67214/t8wk5g53

Makashchieva M.1, Petrovska T.1 , Radeva K.1 ,Endzekceva A.2,1, Todorovska A.1, Durlanova T. 1

1 University Clinic for Surgical Disease “St.Naum Ohridski” Skopje, Macedonia

2 PHI- General Hospital Gevgelija

Abstract

Introduction: Biloma is an encapsulated intrahepatic or extrahepatic collection of bile that most commonly occurs as a consequence of iatrogenic biliary injury following cholecystectomy. Diagnosis is primarily based on imaging, with computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) playing a central role in the detection of postoperative collections and associated biliary leaks. Management is frequently minimally invasive, with image-guided percutaneous drainage, representing an effective therapeutic option.

Case Presentation: We report the case of a 56-year-old female patient who developed an intrahepatic biloma with secondary abscess formation following subtotal cholecystectomy performed for chronic calculous cholecystitis. Initial ultrasound examination suggested a postoperative biloma, which was further characterized by contrast-enhanced CT demonstrating multiple fluid collections, the largest measuring 15 × 10 cm, with features of early abscess formation. CT-guided percutaneous drainage was performed, with evacuation of purulent material. Empiric intravenous antibiotic therapy was initiated, resulting in progressive clinical improvement and normalization of inflammatory markers. Follow-up CT demonstrated significant regression of the collections, while MRCP confirmed a patent biliary tree without evidence of active bile leakage. No ERCP or surgical re-intervention was required.

Conclusion: This case highlights the importance of multimodal imaging in the evaluation and management of postoperative biliary complications and demonstrates that selected patients can be successfully managed with a minimally invasive, conservative approach.

Keywords: Biloma; bile leak; MRCP; percutaneous drainage; subtotal cholecystectomy.

References:

  1. Kapoor V, Baron RL, Peterson MS. Biloma: etiology, imaging, and management. Semin Ultrasound CT MR. 2015;36(2):100-112. doi:10.1053/j.sult.2014.12.009.
  2. Balfour J, Desai H, Ewing A. Hepatic biloma. In: StatPearls (Internet). Treasure Island (FL): StatPearls Publishing; 2025.
  3. Patel N, Jensen KK, Shaaban AM, Korngold E, Foster BR. Multimodality imaging of cholecystectomy complications. Radiographics. 2022;42(5):1303-1319. doi:10.1148/rg.210106.
  4. Ramírez-Giraldo C, Torres-Cuellar A, Van-Londoño I. State of the art in subtotal cholecystectomy: an overview. Front Surg. 2023;10:1142579. `
    doi:10.3389/fsurg.2023.1142579.
  5. Lee W. Experience with partial cholecystectomy in severe cholecystitis. Korean J Hepatobiliary Pancreat Surg. 2013;17(4):171-175.        
    doi:10.14701/kjhbps.2013.17.4.171.
  6. Gössling PAM, Alves GRT, Silva RVA, Corrêa JRM, Marques HF, Haygert CJP. Spontaneous biloma: a case report and literature review. Radiol Bras. 2012;45(1):59-60. doi:10.1590/S0100-39842012000100013.
  7. Della Valle V, Eshja E, Bassi EM. Spontaneous biloma: a case report. J Ultrasound. 2015;18(3):293-297. doi:10.1007/s40477-014-0139-9.
  8. Habte YM, Habte BM, Habte MM, et al. Delayed biloma secondary to an iatrogenic common hepatic duct injury after open cholecystectomy: a rare cause of persistent biliary drainage. Cureus. 2025;17(10):e94486. doi:10.7759/cureus.94486.