Biloma: radiologic diagnosis and treatment

The localized intraabdominal bile collection of biloma has recently been diagnosed in increased frequency dueto the wide spread use of US, CT, DISIDA scintigram, and radiologically guided percutaneous needle aspiration withor without subsequent catheter drainage. The underlying cause of biloma is trauma or iatraogenic injury which included abdominal surgery, percutaneous drainage or PTC. We experienced 20 patients with 22 biloma diagnostically confirmed by DISIDA scan, image-guided needle aspiration, peructaneous catheter drainage and/or operation. Of the 22 biloma, 7 were intrahepatic and 15 were extrahepatic, Of the 15 extrahepatic biloma, 7 were in partially hepatectomized bed, 3 were subhepatic, 3 were right subphrenic and 1 was subcapsular. We found to be infected. Percutaneous drainage was performed on 20 biloma in 18 patients: by a needle aspiration with irrigation on 2patient and by percutaneous catheter drainage on 18 bilomas. Overall success rate of the drainage was 90%. Causeof the two failures were CHD stone with choledochoduodenal fistula and recurrent hemobilia with acutecholecystitis. We describe the processes in reaching the diagnosis of biloma, propensity of biloma to purulentintrahepatic or perihepatic abscess formation, and the necessity of percutaneous radiologic catheter drainage asan optimal management.