BILOMA AFTER SUBTOTAL CHOLECYSTECTOMY-A RARE BUT EXPECTED COMPLICATION

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.