Post-cholecystectomy Hepatic Subcapsular Biloma: A Detailed Case Study on Presentation and Management

TL;DR

This case study describes a rare complication after gallbladder surgery and shows how it was successfully treated with a minimally invasive procedure.

Contribution

The paper presents a rare case of post-cholecystectomy hepatic subcapsular biloma managed with percutaneous drainage instead of ERCP.

Findings

Hepatic subcapsular biloma can occur after laparoscopic cholecystectomy and may present with right upper quadrant pain.

Percutaneous drainage is an effective treatment option for this condition, avoiding more invasive procedures like ERCP.

Abstract

Hepatic subcapsular biloma is a rare but significant complication following laparoscopic cholecystectomy, characterized by the accumulation of bile beneath the hepatic capsule. Despite its infrequency, recognizing this condition is crucial due to its potential for significant morbidity. This report aims to elucidate the presentation, diagnosis, and management of this complication to enhance clinical outcomes. We present the case of a 59-year-old male with a complex medical history including atrial fibrillation, heart failure with preserved ejection fraction, myocardial infarction, chronic obstructive pulmonary disease, hypertension, and alcohol abuse. The patient presented with acute cholecystitis and underwent an uncomplicated laparoscopic cholecystectomy. Postoperatively, he developed right upper quadrant abdominal pain and nausea, leading to the diagnosis of a hepatic subcapsular biloma. The biloma was managed successfully with percutaneous drainage, illustrating a rare complication managed effectively without the need for endoscopic retrograde cholangiopancreatography (ERCP). This case illustrates the need for heightened awareness and swift imaging to diagnose hepatic subcapsular biloma effectively. The management of this patient demonstrates the effectiveness of percutaneous drainage in resolving bilomas and avoiding more invasive procedures such as ERCP. This case adds to the limited literature on the management of post-cholecystectomy hepatic subcapsular biloma and emphasizes the importance of considering this diagnosis in similar clinical scenarios. In conclusion, hepatic subcapsular biloma is a rare complication post-cholecystectomy that requires early recognition and intervention. This case contributes to the body of knowledge, emphasizing the role of imaging in diagnosis and the effectiveness of minimally invasive management strategies. It highlights the educational value of recognizing early postoperative complications, thereby enhancing patient safety and care.

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