Presentation
Vague right upper quadrant pain and jaundice one month after an open cholecystectomy for symptomatic cholelithiasis.
Patient Data
The gallbladder is absent, and intrahepatic biliary ducts are dilated with hyperdense foci in the porta hepatis reflecting post-cholecystectomy biliary duct dilatation and surgical clipping. Linear anterior segment V hypodensity extending from the branch of the left hepatic duct is suggestive of major duct injury.
A larger subdiaphragmatic and subhepatic fluid-attenuating collection measured 21.7 x 12.8 x 7.8 cm that scalloped the liver surface, typical with biloma. Post-contrast image shows identifiable enhancing capsule with adjacent fat stranding.
The common and intrahepatic ducts are dilated. The GB is not visualized. There is a loculated anechoic collection with low-level echodebris involving the right upper and lower quadrant.
Ultrasound-guided percutaneous drainage was performed, and the presence of bile in the drainage bag confirmed biloma following cholecystectomy.
Case Discussion
Post-cholecystectomy biloma is a collection of bile following surgery to remove the gallbladder.
CT imaging characteristics include simple fluid accumulation in close proximity to the biliary system, most frequently in the gallbladder fossa, subphrenic, and Morison pouch.
Simple biloma lacks a distinguishable capsule or enhancing component. In this scenario, an enhancing wall with fat stranding raises the possibility of infected biloma, and sonographic features of low-level echo-debris support complicated biloma.
CT intravenous cholangiography can show communication between the biliary tree and the biloma, allowing the leak to be located.
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