What is a Biloma
A biloma is an encapsulated collection of bile that has leaked outside the biliary tree and accumulated within the abdominal cavity or liver parenchyma. 1, 2, 3
Definition and Pathophysiology
- A biloma represents an extrahepatic or intrahepatic bile collection that forms when bile escapes from the biliary system and becomes walled off by surrounding tissues 2, 3
- The bile accumulates in a defined capsular space, creating a fluid collection that can occur in various locations including the subhepatic space, perihepatic region, or as a subcapsular hepatic collection 4, 5
Common Causes
Iatrogenic injury is the most common cause, particularly following hepatobiliary procedures:
- Laparoscopic cholecystectomy and other biliary surgeries are the leading causes 2
- Liver transplantation carries a 10-25% incidence of biloma formation 1
- Endoscopic procedures including ERCP and percutaneous transhepatic cholangiography can cause bile leaks leading to biloma 4, 6
- Abdominal trauma (blunt or penetrating liver injury) is another significant cause 1
Spontaneous bilomas are uncommon but can occur with:
- Choledocholithiasis causing biliary obstruction and subsequent leak 2, 5
- Cholangiocarcinoma or other biliary strictures 5
- Ascending cholangitis with bile duct rupture 6
Clinical Presentation
Patients typically present with:
- Fever, abdominal pain (especially right upper quadrant), and abdominal distension 1
- Jaundice, nausea, and vomiting 1
- Signs of sepsis if the biloma becomes infected 1
- Symptoms usually develop following hepatobiliary procedures or in the context of biliary obstruction 7, 2