SPONTANEOUS RUPTURE OF AN INTRAHEPATIC BILE-DUCT WITH BILOMA TREATED BY PERCUTANEOUS DRAINAGE AND ENDOSCOPIC SPHINCTEROTOMY

A case of spontaneous rupture of an intrahepatic bile duct with biloma formation treated by percutaneous drainage and endoscopic sphincterot omy is reported. A 73-yr-old woman was admitted with fever and abdomin al pain. There was no past history of abdominal surgery, instrumentati on, or trauma. Ultrasound and computed tomography revealed a massive f luid collection in the abdominal cavity, Endoscopic retrograde cholang iography demonstrated extravasation of contrast medium from a distal b iliary radicle in the left lobe of the liver. After successful treatme nt by percutaneous drainage and endoscopic sphincterotomy, the patient did well. Ultrasound and computed tomography showed resolution of the biloma, Nontraumatic bilomas are very rare: in fact, only 24 cases of spontaneous biloma have been reported. Endoscopic treatment for patie nts with spontaneous bilomas can be safe and effective, and should be considered. (C) 1998 by Am. Coll. of Gastroenterology.