PMC3015378_01
Abdominal CT scan showing subhepatic biloma in the region of the gallbladder fossa.
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F1
An abdominal computed tomography (CT) scan demonstrated a subhepatic fluid collection in the gallbladder fossa (Figure 1).
ERCP cholangiogram demonstrating a residual tapered stenosis of the common duct due to compression by the biloma and associated inflammation. Air bubbles introduced during the procedure are present within the bile duct. A percutaneous drainage catheter is seen within the recently decompressed biloma cavity.
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F2
Two days later, a diagnostic endoscopic retrograde cholangiopancreatography (ERCP) study revealed a tapered narrowing of the common duct with posterior displacement consistent with residual extrinsic mass effect and associated inflammatory changes (Figure 2, 3).
Lateral oblique view of ERCP cholangiogram showing posterior displacement of the common duct consistent with an extrinsic mass effect exerted by the biloma.
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F3
Two days later, a diagnostic endoscopic retrograde cholangiopancreatography (ERCP) study revealed a tapered narrowing of the common duct with posterior displacement consistent with residual extrinsic mass effect and associated inflammatory changes (Figure 2, 3).
Fistulagram through the percutaneous drainage catheter demonstrating a communication between the decompressed biloma cavity and a small branch of the right hepatic duct in the area of the gallbladder fossa.
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F4
A catheter fistulagram demonstrated a small right hepatic duct branch in the area of the gallbladder fossa (Figure 4).
Repeat ERCP cholangiogram showing resolution of the stenosis of the common duct following closure of the biliary fistula and collapse of the biloma cavity.
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F5
After four weeks of drainage, there was complete resolution of the subhepatic biloma, and a repeat ERCP demonstrated a normal common duct with absence of the narrowing seen on the initial study (Figure 5).