Hepatic Biloma

Excerpt

Gould and Patel coined the term “biloma” in 1979 to describe an encapsulated collection of extrahepatic bile secondary to bile leakage into the peritoneal cavity. However, the term “biloma” has evolved to describe any well-circumscribed intra-abdominal bile collection external to the biliary tree. Disruption of the biliary tree can result in either intrahepatic or extrahepatic biloma formation. The current definition of a biloma does not require it to be encapsulated, although many are.

The well-circumscribed margins of the biloma differentiate it from ongoing bile leaks or intraperitoneal free bile. “Choleperitoneum” and “bile ascites” are other terms used to describe free bile in the peritoneum; however, some of the literature uses this term and “biloma” interchangeably.

Iatrogenic injury and abdominal trauma causing damage to the biliary tree resulting in a bile leak are the most common causes of biloma formation. Bilomas are associated with infection, ongoing bile leakage, and mass effect on surrounding structures. While uncommon, bilomas are associated with significant morbidity and mortality if not promptly diagnosed and appropriately managed.

Radiological investigation utilizing ultrasound (US), computed tomography (CT), magnetic resonance (MR) imaging, magnetic resonance cholangiopancreatography (MRCP), or hepatobiliary cholescintigraphy can be used to form a diagnosis and allow planning of accurate minimally invasive management where possible.