Which finding is a localized collection of bile following gallbladder perforation or biliary surgery?

Which finding is a localized collection of bile following gallbladder perforation or biliary surgery?

• A. Biloma
• B. Hemobilia
• C. Pneumobilia
• D. Rokitansky-Aschoff Sinuses

Answer: (A)

A biloma is a localized collection of bile outside the biliary tree that results from a leak after gallbladder perforation or biliary surgery. When bile escapes from the ducts or gallbladder, it can pool in the surrounding tissues, forming a discrete fluid collection. On imaging, a biloma typically presents as a well-defined fluid collection near the gallbladder fossa, often anechoic or with debris if infected, and may be seen surrounding the liver or within the peritoneal/retroperitoneal space depending on the leak’s direction. Clinically, patients may have RUQ pain, fever, or signs of biliary leak, and management usually involves drainage and procedures to seal the leak, such as ERCP with sphincterotomy and stent placement to reduce intraductal pressure and allow the leak to heal. Hemobilia refers to blood entering the biliary tree and presents with right upper quadrant pain plus signs of GI bleeding or jaundice, not a bile-filled collection. Pneumobilia is air within the biliary tree, often seen after biliary instrumentation or surgery, not a fluid collection. Rokitansky-Aschoff sinuses are mucosal outpouchings in the gallbladder wall seen with chronic cholecystitis, not collections of bile.

A biloma is a localized collection of bile outside the biliary tree that results from a leak after gallbladder perforation or biliary surgery. When bile escapes from the ducts or gallbladder, it can pool in the surrounding tissues, forming a discrete fluid collection. On imaging, a biloma typically presents as a well-defined fluid collection near the gallbladder fossa, often anechoic or with debris if infected, and may be seen surrounding the liver or within the peritoneal/retroperitoneal space depending on the leak’s direction. Clinically, patients may have RUQ pain, fever, or signs of biliary leak, and management usually involves drainage and procedures to seal the leak, such as ERCP with sphincterotomy and stent placement to reduce intraductal pressure and allow the leak to heal.

Hemobilia refers to blood entering the biliary tree and presents with right upper quadrant pain plus signs of GI bleeding or jaundice, not a bile-filled collection. Pneumobilia is air within the biliary tree, often seen after biliary instrumentation or surgery, not a fluid collection. Rokitansky-Aschoff sinuses are mucosal outpouchings in the gallbladder wall seen with chronic cholecystitis, not collections of bile.