Clinical Journal of Gastroenterology

, Volume 11, Issue 2, pp 167–171 | Cite as

Intrahepatic subcapsular biloma after endoscopic retrograde cholangiopancreatography treated by endoscopic biliary drainage

  • Hiroaki Igarashi
  • Hiroko Yamashita
  • Kiyoshi Tsuchiya
  • Dai Sugimoto
  • Itsuro Ogata
Case Report
  • 75 Downloads

Abstract

Several major complications from endoscopic retrograde cholangiopancreatography (ERCP), including pancreatitis, cholangitis, and hemorrhage have been discussed in detail; however, a few uncommon but severe complications have been reported. We encountered an unusual case of post-ERCP intrahepatic subcapsular biloma. An 89-year-old woman with a 25-mm mass located at the hepatic hilum, suggestive of cholangiocarcinoma, underwent ERCP which demonstrated complete stricture of the common hepatic duct. Subsequently, two plastic stents were placed from the common bile duct to the right and left intrahepatic branches. On day 3, serum inflammatory markers were elevated and computed tomography revealed a large subcapsular fusiform fluid collection in the right liver, consistent with biloma. On day 6, the biloma ruptured and 500 ml of biliary ascites were removed. On day 8, endoscopic nasobiliary drainage via the right intrahepatic branch was performed because of recurrence of biliary ascites. After the procedure, 150 ml of bile was collected through the drain every day and no ascites recurred. We believe that minor injury to the right intrahepatic bile duct due to guidewire manipulation caused the biloma. Biloma may become apparent several days after ERCP, and endoscopic biliary drainage placement adjacent to the bile duct rupture site can stop bile leakage.

Keywords

Bile duct injury Biloma Complication Endoscopic drainage ERCP 

Notes

Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest for this article.

Human/animal rights

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from the family for being included in the study.

References

  1. 1.
    Kwon C, Song SH, Hahm KB, et al. Unusual complications related to endoscopic retrograde cholangiopancreatography and its endoscopic treatment. Clin Endosc. 2013;46:251–9.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Chavalitdhamrong D, Donepudi S, Pu L, et al. Uncommon and rarely reported adverse events of endoscopic retrograde cholangiopancreatography. Dig Endosc. 2014;26:15–22.CrossRefPubMedGoogle Scholar
  3. 3.
    Gould L, Patel A. Ultrasound detection of extrahepatic encapsulated bile: “biloma”. Am J Roentgenol. 1979;132:1014–5.CrossRefGoogle Scholar
  4. 4.
    Kuligowska E, Schlesinger A, Miller KB, et al. Bilomas: a new approach to the diagnosis and treatment. Gastrointest Radiol. 1983;8:237–43.CrossRefPubMedGoogle Scholar
  5. 5.
    Cervantes J, Rojas GA, Ponte R. Intrahepatic subcapsular biloma. A rare complication of laparoscopic cholecystectomy. Surg Endosc. 1994;8:208–10.CrossRefPubMedGoogle Scholar
  6. 6.
    Pavlidis TE, Atmatzidis KS, Papaziogas BT, et al. Biloma after laparoscopic cholecystectomy. Ann Gastroenterol. 2002;15:178–80.Google Scholar
  7. 7.
    Sharda S, Sharma A, Khullar R, et al. Postlaparoscopic cholecystectomy biloma in the lesser sac: a rare clinical presentation. J Minim Access Surg. 2015;11:154–6.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Bohlsen D, Kalmar P, Schreiber F, et al. Percutaneous transhepatic biliary drainage and endoscopic retrograde cholangiography in biloma − a rendezvous procedure. Endoscopy. 2013;45:E292–3.CrossRefPubMedGoogle Scholar
  9. 9.
    Dupas JL, Mancheron H, Sevenet F, et al. Hepatic subcapsular biloma. An unusual complication of endoscopic retrograde cholangiopancreatography. Gastroenterology. 1988;94:1225–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Alkhateeb HM, Aljanabi TJ, Al-azzawi KH, et al. Huge biloma after endoscopic retrograde cholangiopancreatography and endoscopic biliary sphincterotomy. Int J Surg Case Rep. 2015;16:7–11.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Anand RJ, Ferrada PA, Darwin PE, et al. Endoscopic retrograde cholangiopancreatography is an effective treatment for bile leak after severe liver trauma. J Trauma. 2011;71:480–5.CrossRefPubMedGoogle Scholar
  12. 12.
    Ferrusquia-Acosta JA, Navascues CA, Garcia MR. Giant biloma as a result of a blunt abdominal trauma: a case report. Rev Esp Enferm Dig. 2015;107:768–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Kam J, Hugh TJ, Joseph A. Delayed biloma formation in a patient with blunt liver injury after low velocity trauma. Br J Hosp Med (Lond). 2017;78:110–1.CrossRefGoogle Scholar
  14. 14.
    Bas G, Okan I, Sahin M, et al. Spontaneous biloma managed with endoscopic retrograde cholangiopancreatography and percutaneous drainage: a case report. J Med Case Rep. 2011;5:1–3.CrossRefGoogle Scholar
  15. 15.
    Valle VD, Eshja E, Bassi EM. Spontaneous biloma: a case report. J Ultrasound. 2015;18:293–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Georgiou GK, Tsili A, Batistatou A, et al. Spontaneous biloma due to an intrahepatic cholangiocarcinoma: an extremely rare case report with long term survival and literature review. Ann Med Surg. 2017;14:36–9.CrossRefGoogle Scholar
  17. 17.
    Furuta T, Kato M, Ito T, et al. 6th report of endoscopic complications: results of the Japan Gastroenterological Endoscopy Society Survey from 2008 to 2012 (in Japanese). Gastroenterol Endosc. 2016;58:1466–91.Google Scholar
  18. 18.
    Kayashima H, Ikegami T, Kasagi Y, et al. Liver parenchyma perforation following endoscopic retrograde cholangiopancreatography. Case Rep Gastroenterol. 2011;5:487–91.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Rabie ME, Faris SA, Nasser A, et al. Parenchymal guidewire perforation during ERCP: an unappreciated injury. Case Rep Surg. 2015;2015:670323.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Wu HA, Dixon E, May GR, et al. Management of perforation after endoscopic retrograde cholangiopancreatography (ERCP): a population-based review. HPB (Oxford). 2006;8:393–9.CrossRefGoogle Scholar
  21. 21.
    McArthur KS, Mills PR. Subcapsular hepatic hematoma after ERCP. Gastrointest Endosc. 2008;67:379–80.CrossRefPubMedGoogle Scholar
  22. 22.
    Del Pozo D, Moral I, Poves E, et al. Subcapsular hepatic hematoma following ERCP: case report and review. Endoscopy. 2011;43:E164–5.CrossRefPubMedGoogle Scholar
  23. 23.
    Crellana F, Irarrazaval J, Galindo J, et al. Subcapsular hepatic hematoma post ERCP: a rare or an underdiagnosed complication? Endoscopy. 2012;44:E108–9.CrossRefGoogle Scholar
  24. 24.
    Fei BY, Li CH. Subcapsular hepatic haematoma after endoscopic retrograde cholangiopancreatography: an unusual case. World J Gastroenterol. 2013;19:1502–4.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Patil M, Sheth KA, Adarsh CK, et al. An unusual experience with endoscopic retrograde cholangiopancreatography. J Dig Endosc. 2013;4:114–6.CrossRefGoogle Scholar
  26. 26.
    Enns R, Eloubeidi MA, Mergener K, et al. ERCP-related perforations: risk factors and management. Endoscopy. 2002;34:293–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Lai CHE, Lau WY. Management of endoscopic retrograde cholangiopancreatography-related perforation. Surgeon. 2008;6:45–8.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Gastroenterology 2017

Authors and Affiliations

  1. 1.Department of GastroenterologyKawakita General HospitalTokyoJapan

Personalised recommendations