A biloma is a circumscribed abdominal collection of bile outside the biliary tree. It occurs when there is excess bile in the abdominal cavity. It can occur during or after a bile leak. There is an increased chance of a person developing biloma after having a gallbladder removal surgery, known as laparoscopic cholecystectomy. This procedure can be complicated by biloma with incidence of 0.3–2%. Other causes are liver biopsy, abdominal trauma, and, rarely, spontaneous perforation. The formation of biloma does not occur frequently. Biliary fistulas are also caused by injury to the bile duct and can result in the formation of bile leaks. Biliary fistulas are abnormal communications between organs and the biliary tract. Once diagnosed, they usually require drainage. The term "biloma" was first coined in 1979 by Gould and Patel. They discovered it in a case with extrahepatic bile leakage. The cause of this was trauma to the upper right quadrant of the abdomen. Originally, biloma was described as an "encapsulated collection" of extrahepatic bile. Biloma is now described as extrabiliary collections of bile that can be either intrahepatic or extrahepatic. The most common cause of biloma is trauma to the liver. There are other causes such as abdominal surgery, endoscopic surgery and percutaneous catheter drainage. Injury and abdominal trauma can cause damage to the biliary tree. The biliary tree is a system of vessels that direct secreations from the liver, gallbladder, and pancreas through a series of ducts into the duodenum. This can result in a bile leak which is a common cause of the formation of biloma. It is possible for biloma to be associated with mortality, though it is not common. Bile leaks occur in about one percent of causes.
Signs and symptoms
Symptoms include diffused or localized abdominal pain without a fever. A blood test will show leukocytosis and nonspecific liver test abnormalities. Symptoms of Biloma can range from severe to having no symptoms at all. If a patient presents with no symptoms, this event makes them nonspecific. Other symptoms can range from abdominal pain, distention, jaundice, and fever. Fevers are usually due to leukocytosis being present. Physical examination revealed epigastric fullness and right upper quadrant discomfort. This is usually the result of a disruption of the bile tree. In a case of infected biloma, the symptoms would include nausea, vomiting, and fever.
Patients may present with acute symptoms, no symptoms or a wide range of symptoms. This makes diagnosing biloma challenging. Early signs of biloma after traumatic injury include persistent abdominal distention, bloating, and/or anorexia. Patients who have undergone hepatobiliary surgery or laparoscopic cholecystectomy are more at risk for developing biloma. Consequently, these patients should be observed more frequently so it does not turn into an infection.
Etiology
Research and diagnosis have proven that bilomas are secondary to biliary obstruction. This process is caused by trauma or iatrogenic procedures. Iatrogenic cases are procedures such as laparoscopic cholecystectomy, endoscopic retrograde cholangiopancreatography (ERCP), radiofrequency ablation (RFA), liver transplant, resection, and biopsy."
Pathophysiology
Leakage of bile and destruction of the biliary tree are the most common causes of biloma. Destruction of the billary tree means that there is a blockage in the pancreatic or bile duct. Bile ducts are vessels that carry from the liver to the gallbladder. When bile becomes blocked, pancreatic juices cannot be transported to the intestines. Bile leakage causes inflammation in abdominal tissues or liver parenchyma. This results in fibrosis and encapsulation. Bile leakage is located at the biliary tube site with rare occurrences at the anastomotic site. Greenish-yellow bile is usually present as well as blood. This will occur if there is an infection present. Infections can lead to sepsis, abscess formation and inflammatory response.