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.

We report a case of an 86-year-old Hispanic male who presented with generalized itching and jaundice. Computed tomography (CT) imaging revealed a hepatic mass and an extensive spontaneous biloma, a condition rarely associated with malignancy. Subsequent biopsy of the mass confirmed moderately differentiated adenocarcinoma of the pancreaticobiliary tract. The patient underwent successful percutaneous drainage of the biloma and was discharged with a plan for further outpatient management. This case study highlights a rare manifestation of spontaneous biloma related to malignancy, broadening the clinical understanding of its association with malignancy, diagnosis, and management.

Cholangiocarcinomas are tumors that arise from the ductal epithelium of the intrahepatic or extra-hepatic bile ducts. Patients are usually asymptomatic or may present with weight loss, fatigue, loss of appetite and abdominal pain (intrahepatic cholangiocarcinomas) or jaundice (extra-hepatic cholangiocarcinomas). Subcapsular bile vessel rupture, due to intrahepatic cholangiocarcinoma, is an extremely rare clinical presentation, which is an emergent and potentially life-threatening complication. We report the case of a 79-year-old female patient suffering from an intrahepatic cholangiocarcinoma that completely obliterated the left main hepatic duct. This obstruction in intrahepatic bile flow had resulted in intraperitoneal rupture of subcapsular bile vessels (not infiltrated by the tumor) of the left liver lobe and formation of spontaneous biloma. The patient was admitted for acute abdominal pain. Computed tomography (CT) and Magnetic Resonance Imaging (MRI) revealed the tumor and an upper abdominal fluid collection. Since the patient was hemodynamically stable and afebrile, a CT-guided percutaneous aspiration of the collection was undertaken, showing a biloma. A left hepatectomy was performed two weeks later and today, sixty months since the incident, the patient enjoys good health, with no signs of local recurrence or distant metastases. Intraperitoneal rupture of bile ducts and subsequent spontaneous biloma formation, due to an intrahepatic cholangiocarcinoma which completely obstructed the left main hepatic duct, is a unique situation and this is the first time to be reported. Prompt surgical management can lead to successful treatment of this rare and difficult entity.

Biloma is an encapsulated bile collection outside the biliary tree due to a bile leak. It is occasionally found following traumatic liver injury or iatrogenic injury to the biliary tract, induced either during an endoscopic or surgical procedure. It is a rare complication of transcatheter arterial embolization (TAE). Although biloma can be shrunk by appropriate aspiration or drainage in majority of cases, we report a case of intrahepatic biloma following repeated TAE for hepatocellular carcinoma (HCC) and complicated by infection and intrahepatic stones. This particular constellation of problems has not been reported before and the intrahepatic stones need to be removed by percutaneous procedure.

Biloma formation has not been reported to occur after a routine percutaneous liver biopsy. It is an uncommon yet well known complication of laparoscopic cholecystectomy. We report the development of a biloma within 1 week after a liver biopsy with a Jamshidi needle in a non-cirrhotic patient with hepatitis C. The biloma was large and caused a dramatic alteration of the hepatic contour and displaced the liver medially, resulting in gastric outlet obstruction. The biloma was treated successfully with percutaneous drainage. We believe this to be the first report of a large biloma causing gastric outlet obstruction as a complication of percutaneous liver biopsy.