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ERCP showing a post cholecystectomy stricture at the level of the cystic duct.
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Severe abdominal distension 2 months after ERCP, ES and CBD stenting.
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Two weeks later, the patient started to complain of abdominal discomfort, epigastric heaviness and fullness, anorexia, nausea, repeated vomiting with gradual abdominal distension, reaching a huge size after two months (Fig. 2).
CT scan of the abdomen in the transverse section showing the large fluid collection.
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A tube drain fixed to the anterior abdominal wall.
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The abdomen remained distended, so we took the patient to the operating theatre, used five millilitres of local anaesthetic lidocaine solution 2% injected locally just above the umbilicus, and performed a one-centimetre transverse skin incision to introduce a Fr 20 tube drain into the cavity of the biloma through the anterior abdominal wall fixed by silk suture (Fig. 5).
Some of the amount of the drained fluid.
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Approximately 11 l of the same fluid was drained (Fig. 6), the abdomen collapsed with no more fluid discharge after the third day (Fig. 5), the tube drain was removed at the seventh day, and the patient obtained relief from all of his symptoms, has been doing well and was followed for one year with no recollection or any other related complaint.