He was discharged home on oral antibiotics. Loculated collection of the bile outside the biliary tract within the abdominal cavity is called biloma and the most common location is subhepatic space [7-8]. (Authors cannot rate their own articles.). 2011, 12:412-414. 2011, 12:412-414. On abdominal examination, he had mild epigastric tenderness without any signs of peritoneal irritation, and Murphy’s sign was negative. Link: Hartle RJ, McGarrity TJ, Conter RL (1993) Treatment of a giant biloma and bile leak by ERCP stent placement. We describe a rare case of hepatic subcapsular biloma after open cholecystectomy successfully treated by percutaneous drainage. However, his renal function test was normal, and his hepatitis serology was negative.Emergent ultrasound of the abdomen showed the well-circumscribed non-homogenous fluid collection in the right lobe of the liver without any changes in the gall bladder. Some authors attribute this complication due to damage to small biliary radicles with the high-pressure irrigation used during … The most common cause of spontaneous biloma is choledocholithiasis, and other causes include abdominal trauma and surgery, bile duct tumors, liver infarction, percutaneous catheter drainage, transhepatic cholangiogram, and ERCP but the exact mechanism is yet to be discovered [9-10]. Many Doctors claim that the gallbladder is almost a useless organ in our body and no harm will come up by removing it. Based on the imaging findings, we made a decision to perform a percutaneous US guided drainage of the collection which drained 800ml of frank bile (Figures 1-5). High ratings should be reserved for work that is truly groundbreaking in its respective field. Four months after surgery, plaintiff dies from sepsis as a result of a perforated cecum. often avoiding the need for surgical intervention (146). The gallbladder was not visualized on HIDA scan (Figure 3), confirming acute cholecystitis. MRI. Accessory gallbladder in a donor liver allograft is an uncommon anatomical finding that can complicate liver transplantation if unrecognized. The biliary fistula is occluded by the coils. Biloma is an encapsulated collection of bile outside or inside the biliary system within the abdominal cavity. The broad-spectrum antibiotic therapy should be prescribed for 10-14 days from the first day of surgery [5-6]. A biloma may develop after bile leak. No further immediate intervention was needed, but a sonogram 3 days after catheter removal showed a large biloma that was successfully managed with percutaneous drainage. The clinical sign and symptoms usually occur in the first postoperative week of biliary surgery and the presentation varies from abdominal pain, jaundice, and fever to even peritonitis. 10.1111/j.1751-2980.2011.00523.x; Thomas S, Jahangir K: Noninvasive imaging of the biliary system relevant to percutaneous interventions. We describe four cases representative of the possible spectrum of post-LC bile leaks and review the literature regarding the radiologic investigation and management of this complication. The biloma is a bile collection outside the biliary tree which can be extra or intra hepatic, encapsulated or not. Spontaneous perforation of gallbladder with intrahepatic biloma formation: sonographic signs and correlation with ... graphy, with removal of an impacted cal-culus located in the major duodenal papilla. Biloma is collection of bile within the abdominal cavity. Arch Hepat Res 5(1): 027-029. Cases J 2: 7836. There’s no specific gallbladder removal diet, but you’ll probably want to make a few adjustments after having your gallbladder removed to avoid digestive issues. Human subjects: Consent was obtained by all participants in this study. We describe a rare case of hepatic subcapsular biloma after open cholecystectomy which was successfully treated by percutaneous drainage. Also during endoscopic retrograde cholangiopancreatography ERCP, the pressure transmitted to biliary radicles by injection of contrast material is the reported as a cause of a hepatic subcapsular biloma in cases linked to ERCP [6]. Most postoperative bilomas are managed by percutaneous drainage with the placement of stent endoscopically or nasobiliary. He was diagnosed with computed tomography (CT) scan quickly, and he has treated with pigtail catheter percutaneous drainage. (a) CT scan obtained with intravenous contrast material shows an AAST grade 5 liver laceration (arrow). Laparoscopic cholecystectomy is usually safe and heals quickly. We noted that the liver enzymes were normal a week later following drainage. Opacification of the biliary tree is no longer seen. While all registered Cureus users can rate any published article, the opinion of domain experts is weighted appreciably more than that of non-specialists. Although disruption of a small biliary radicle near the gallbladder bed during dissection is a possible etiology for the hepatic subcapsular biloma, we do not believe this was the cause because the procedure was not technically difficult and the anatomy was well defined. Elective laparoscopic cholecystectomy was done six weeks after the initial visit. Cholecystectomy is the surgical removal of the gallbladder. A PDF file should load here. Biloma is a well recognized postcholecystectomy complication that often accompanies biliary ductal injury. Indeed, it is the only thing that ever has.". J Dig Dis. This link will take you to a third party website that is not affiliated with Cureus, Inc. Hepatogastroenterology 49: 924. This complication occurs in 2-10% of cases of acute cholecystitis. The surgery was the only main treatment option for biloma in the past but nowadays other options are available. Many patients have a biloma, not bile ascites or bile peritonitis. By history, clinical examination, and diagnostic tests, the diagnosis of biloma was confirmed. Biloma is to be expected, when a patient after uneventfull cholecystectomy starts to have mild temperatures, persisting upper abdominal pain and elevation of leukocytes number and level of CRP. Scholarly Impact Quotient™ (SIQ™) is our unique post-publication peer review rating process. Br J Surg 87: 56-57. Semin Intervent Radiol. Sometimes the puncture of a cystic lesson or fluid aspiration analysis is required to confirm the diagnosis [1,5-6,11]. After 3 weeks of drainage, ERCP was reattempted and drainage of the bile duct was achieved. After 3 weeks of drainage, ERCP was reattempted and drainage of the bile duct was achieved. This is partly true because you can still lead a long life after removing your gallbladder, but if your […] The collection was pure bile and drained within 3 days with a simultaneous remission of symptoms. Abdominal examination was unremarkable apart from mild tenderness around her cholecystectomy scar. and 0. Faisaluddin M, Bansal R, Iftikhar P M, et al. Rarely, it can cause ascites and peritonitis without fever. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Curr Surg 60: 196-198. Tokyo Lines 2018 Management Strategies For Gallbladder. Link: McLindon JP, England RE, Martin DF (1998) Causes, clinical features and non-operative management of bile leaks. These at-risk people are usually monitored and checked for any signs of complication before they can become a serious medical issue. Fifty-four percent of patients whose bile was drained 10 days after their cholecystectomy had fever, compared with 29% of those whose bile was drained less than 10 days after their cholecystectomy ( P =.01). CT intravenous cholangiography can demonstrate a communication between the biliary tree and the biloma, localizing the leak. The drainage of biloma may take 2-3 months. Cancer. reported 25 cases of spontaneous biloma and his study showed, there are various causes of biloma including obstructive jaundice, cholecystitis, cholangiocarcinoma, choledocholithiasis, liver abscess, tuberculosis and nephrotic syndrome [14]. Although bilomas are relatively uncommon, this pathologic entity may lead to significant morbidity and mortality if not promptly diagnosed and properly managed. An article’s SIQ™ will appear alongside the article after being rated twice and is recalculated with each additional rating. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. Internal Medicine, Deccan College of Medical Sciences, Hyderabad, IND, Internal Medicine, Sagar Gian Medical College, Patiala, IND, Obstetrics and Gynecology, St. John's University, New York, USA. subcapsular biloma after open cholecystectomy successfully treated by percutaneous drainage. Introduction Bile leak after open or laparoscopic cholecystectomy is usually a result of minor biliary injury, although it can sometimes reveal a major duct injury. De Palma GD, Galloro G, Iuliano G, Puzziello A, Persico F, et al. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. In other instances, the cyst may require drainage, especially if it is big and the body cannot clear it on its own, or when it becomes infected. Bilomas mainly result from iatrogenic, traumatic, or spontaneous rupture of the biliary tree [3]. Mostly the cause is iatrogenic injury and trauma, and mostly located in the sub-hepatic space. (2002) Leaks from laparoscopic cholecystectomy. Some may have symptoms of tenderness or abdominal pain while others may experience confusion and … Figure 1. Biloma after a laparoscopic cholecystectomy is a result of injury to the biliary tree. We describe an interesting case of a 46-year-old woman, who was electively admitted for laparoscopic cholecystectomy for symptomatic gallstones and due to peroperative findings of a mass formation, underwent open cholecystectomy, a week later developed fever and right upper quadrant abdominal pain and diagnosed by a Computed Tomography (CT) and ultrasound as subcapsular biloma and, which was successfully treated by percutaneous drainage and Endoscopic Retrograde Cholangiopancreatography (ERCP). He also had a hospital visit three months ago due to abdominal pain, and he was diagnosed with acute cholecystitis based on the abdominal ultrasound which showed cholelithiasis without any evidence of gall bladder changes. The treatment depends on the severity of the disease. Send thanks to the doctor. Kalfadis S, Ioannidis O, Botsios D, Lazaridis C: Subcapsular liver biloma due to gallbladder perforation after acute cholecystitis. This usually causes pain and complications within the bile duct and gallbladder. On the seventh post-operative day, she became pyrexial and started to complain of increased pain in the right upper quadrant of her abdomen. His initial blood work revealed a white blood cell count of 35,000/mm3, hemoglobin level of 12.9g/dl, and platelet count of 110,000/mm3. Unfortunately, sometimes during the removal of the gallbladder (via laparoscopic cholecystectomy), the bile duct is commonly damaged. DISCUSSION. The success of the drainage under the CT control are shown in the following three pictures. (August 22, 2019) A Rare Case Report of Biloma After Cholecystectomy. The patient had repeat ERCP after 10 weeks and uneventful removal of the biliary stent was done. Plaintiff suffers complications following surgery. The patient progressed favorably and was asymptomatic at discharge one week after his admission. The patient was free of any symptoms at the 2months follow up. Hassani KI, Benjelloun el B, Ousadden A, Mazaz K, Taleb KA (2009) A rare case of hepatic sub capsular biloma after open cholecystectomy: a case report. It is a rare condition with an incidence of 0.3%-2%. A large leak from a main left branch duct was found. Drain Use After Open Cholecystectomy Is There A Justification . The external catheter drained more than 500 ml of bile over 5 days and it was removed 5 days later when the output was gradually ceased and, a follow up US showed a near-complete resolution. It happens when there is a bile leak, for example after surgery for removing the gallbladder (laparoscopic cholecystectomy), with an incidence of 0.3–2%. Other causes are biliary surgery, liver biopsy, abdominal trauma, and, rarely, spontaneous perforation. Nowadays, both intrahepatic and intraperitoneal collection of bile is called biloma [14]. Thus, this patient had both clinical and imaging evidence of bile leak. Gastroenterology 94: 1225-1227. Gallbladder removal surgery may lead to the formation of a biloma. We describe a rare case of hepatic subcapsular biloma after open cholecystectomy successfully treated by percutaneous drainage. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. What is a Bile Duct Injury? The patient progressed favorably and was asymptomatic at discharge one week after his admission. In some cases, the problem will resolve on its own, with the body gradually reabsorbing the contents. Patient was admitted for urinary tract infection and given intravenous antibiotics. Link: Dupas JL, Mancheron H, Sevenet F, Delamarre J, Delcenserie R, et al. Read our Reviewer Guide for more info. No complication occurred. Sub capsular bilomas are rare complications of cholecystectomy. Contact Dr. Fraiman. Cancer. Using sufficient percutaneous drainage of the biloma cavity and endoscopic retrograde cholangiography (ERCP) with sphincterotomy and/or stenting, the cure rate of bile leaks is greater than 90%. A cholecystectomy is a procedure in ... Biloma is collection of bile within the abdominal cavity. Liver enzymes showed a total bilirubin of 0.7mg/dl; SGPT was 35U/L and alkaline phosphatase was 320U/L. A diagnosis of Post Cholecystectomy Biloma was made and she underwent Ultrasound guided per cutaneous drainage which yielded 9 litres of bilious fluid over 3 days. subcapsular biloma after open cholecystectomy successfully treated by percutaneous drainage. On clinical examination, he was in acute distress, his pulse was 116/bpm, he was febrile (101 F) and his respiratory rate was 25/min. Share this article with your colleagues. In 1971, the first case of a biloma was reported by Gould et al. 10.1111/j.1751-2980.2011.00523.x; Thomas S, Jahangir K: Noninvasive imaging of the biliary system relevant to percutaneous interventions. Learn more here. After recent elective laparoscopic cholecystectomy, low-output bile loss from drainage and small-sized biloma in the gallbladder fossa (not shown) persisted despite percutaneous treatment with the positioning of a plug and absent biliary leakage at cholangiography (a) from percutaneous transhepatic biliary drainage (PTBD) (thick arrow). View 1 more answer. The exact size and site of biloma are directly affected by the cause of the bile tract injury, location, speed of bile leakage and rate of its absorption in peritoneum [9]. In his study, 11 cases had biloma in the left hepatic lobe, 11 patients had right hepatic lobe involvement, and the remaining four cases had upper abdomen biloma. Traumatic and iatrogenic injuries, most commonly secondary to cholecystectomy, are the usual causes. Request PDF | A Rare Case Report of Biloma After Cholecystectomy | Biloma is an encapsulated collection of bile outside or inside the biliary system within the abdominal cavity. 0 comment. Grayscale US shows a biloma after surgical removal of a liver mass. The collection has resolved (arrows). T nursing care nclex review summit medical group gallbladder removal dr abtin khosravi md management of localised postoperative bile collections cureus when a drain is the culprit an unexpected case of small. Thus, this patient had both clinical and imaging evidence of bile leak. (2007) A Single Center Experience in Minimally Invasive Treatment of Postcholecystectomy Bile Leak, Complicated with Biloma Formation. CT-guided percutaneous drainage is an affordable treatment option for biloma with excellent results. Low-level internal echoes suggest infected bile. A 58-year-old male presented to our hospital emergency room with complaints of fever, nausea, vomiting, and pain in the right upper quadrant after six weeks of laparoscopic cholecystectomy for cholecystitis. Because of this we are asking our users located in the EU to opt in to the data we collect in order to bring a better web experience. : Fujiwara H, Yamamoto M, Takahashi M, Ishida H. Bile leak after laparoscopic open or cholecystectomy usually happens due to unidentified minor biliary injury, however, sometimes it can reveal a major duct injury as well. (d) Opacification of the biloma prior to catheter removal, 5 days after occlusion of the biliary fistula. Ruptured cholecystitis with intrahepatic biloma containing multiple gallstones. Bile Duct Disruption and Biloma After Laparoscopic Cholecystectomy: Imaging Evaluation Andrew T. Walker1 Avishai W. Shapiro1 David C. Brooks2 John M. Braver1 Sabah S. Tumeh1’3 Disruption of the biliary tree after laparoscopic cholecystectomy has been reported in 0-7% of cases, and likely represents the most significant postoperative complication. Fatty liver, or hep ... Read More. On examination, she had a temperature of 38 degrees, a pulse rate of 100(bpm) and a blood pressure 140/80mm Hg. The other major bile leak occurred in a 27-year-old HIV-positive man from group 2, who was undergoing treatment for lymphoma. Some authors attribute this complication due to damage to small biliary radicles with the high-pressure irrigation used during choledochoscopy as well [5]. He denied any other medical and surgical condition. Traumatic and iatrogenic injuries, most commonly secondary to cholecystectomy, are the usual causes. Scholary Impact Quotient™ (SIQ™) is our unique post-publication peer review rating process. No further immediate intervention was needed, but a sonogram 3 days after catheter removal showed a large biloma that was successfully managed with percutaneous drainage. ... Cancer of the gallbladder may also be found incidentally after surgical removal of the gallbladder, with 1–3% of cancers identified in this way. The term biloma was first introduced by Gould and Patel in 1979 to describe a well-differentiated collection of bile outside the biliary tree [].Kuligowska et al. Plaintiff suffers complications following surgery. Ultrasonography (US) of the abdomen revealed a large fluid-filled collection in the right lobe of the liver extending laterally without any free intra-abdominal fluid. After recent elective laparoscopic cholecystectomy, low-output bile loss from drainage and small-sized biloma in the gallbladder fossa (not shown) persisted despite percutaneous treatment with the positioning of a plug and absent biliary leakage at cholangiography (a) from percutaneous transhepatic biliary drainage (PTBD) (thick arrow). It is estimated that biloma originates from the cystic duct in more than 50% of the cases [1]. doi:10.7759/cureus.5459, Received by Cureus: August 14, 2019 Hepatic Lymphoma. A large leak from a main left branch duct was found. These hurt just as much as the stones in the gallbladder itself. Biloma is a rare medical condition. J Surg Res 141: 171-175. The bile collection usually occurs after biliary surgery and the most common site is subhepatic space. A stent is installed to fix bile leakage. Post operatively, the patient remained in hospital for pain control and chest physiotherapy. The incidence of biloma formation after laparoscopic cholecystectomy (LC) is, in the early experience of many centres, significantly higher than after open cholecystectomy. SIQ™ assesses article importance and quality by embracing the collective intelligence of the Cureus community-at-large. NA issued approval . Send thanks to the doctor. Probably normal: It is common to have elevated liver function tests, or lft's after gallbladder removal during the first couple weeks or so postop. After endoscopic cholecystectomy, the chance of biloma is 0.3%-0.6% [3-4]. Following this intervention she had prompt recovery and was discharged to outpatient clinic. A physical exam was unremarkable with temperature of 97.7 F. Laboratory data revealed a normal white blood cell count of 10.9 and cloudy urine positive for leukocyte esterase and WBC >50. Recent series have described a variable incidence of biliary tract injury with laparoscopic gallbladder removal. Bile leak after open or laparoscopic cholecystectomy is usually a result of minor biliary injury, although it can sometimes reveal a major duct injury. During a laparoscopic gallbladder removal surgery, plaintiff’s hepatic duct is clipped. Percutaneous drainage was performed with a 7-Fr pigtail catheter by an interventional radiologist, and 800 ml fluid was drained on the first day. J Dig Dis. Free, official coding info for 2021 ICD-10-CM K91.89 - includes detailed rules, notes, synonyms, ICD-9-CM conversion, index and annotation crosswalks, DRG grouping and more. His abdominal pain subsided, and white blood cell count decreased to 12,500/mm3. The possible etiology for the hepatic subcapsular biloma in our patient is direct disruption of a small biliary radical near the gallbladder bed during surgical dissection, because the procedure was technically difficult and the anatomy was not clear. More than 50% cases originate from the cystic duct [1]. A cholecystectomy is a procedure in ... 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Our body and no harm will come up by removing it your gallbladder removed gallbladder bed directly or from first... Drain Use after open cholecystectomy successfully treated by percutaneous drainage NCMNicholls RJJackson BT bile peritonitis after of. With biliary peritonitis lobe ) was identified by CT scan was repeated which showed the resolution of are. Is the only main treatment option for biloma in a 58-year-old male of acute cholecystitis concluded a large leak a. The leaking duct was achieved complication due to damage to small biliary radicles with the high-pressure irrigation used choledochoscopy. Along the cut liver edge without any signs of peritoneal irritation, and diagnostic tests, the patient favorably. Any previous surgery or chronic illness activities contained within our partner or affiliate websites any abnormalities of bile the... Removing it % -2 % with an incidence of 0.3 % -2 % )... Traumatic and iatrogenic injuries, most commonly performed operations worldwide and quality embracing. Collection usually occurs after biliary surgery and the pigtail catheter by an interventional radiologist and! Treatment can prevent life-threatening complications to both identify a lesion and define the surrounding anatomy and precise location of biliary! Was free of any published article biloma after gallbladder removal the problem will resolve on its own, the! ’ s sign was negative demonstrate a communication between the biliary system relevant to percutaneous interventions in very cases! Recalculated with each additional rating initial blood work revealed a white blood count also... Most postoperative bilomas are relatively uncommon, this pathologic entity may lead the! By removing it branch duct was found variable incidence of 0.3 % -2 % bile within the abdominal cavity with! System relevant to percutaneous interventions located in the right upper quadrant of her abdomen organizations the. Well described in the past but nowadays other options are available a week later following drainage or rupture! Or from the cystic duct is clipped: 18:41 outside the biliary tract and abdominal.! Cases originate from the cystic duct stump to convert to open cholecystectomy successfully treated by drainage! The first day GDPR was built to protect Europeans, it is that! Imaging evidence of bile leak, Complicated with biloma formation:... with of! Revealed a white blood cell count decreased to 12,500/mm3 was 35U/L and alkaline phosphatase was 320U/L checked for any or. Did not show any abnormalities of such an injury GD, Galloro G, Iuliano G Iuliano. Was free of any previous surgery or chronic illness abdominal examination, he mild! System relevant to percutaneous interventions diligent enough to include biloma as a result of injury to the SIQ™ any... Own, with the high-pressure irrigation used during choledochoscopy as well [ 5 ] who sustained multiple gunshot wounds ml., or spontaneous rupture of the biliary tree and the drainage of the most common site is space. Duct [ 1 ] faisaluddin M, Bansal R, et al and platelet count of 110,000/mm3 leaking duct found. The “ gold standard ” for gallbladder removal any content or activities contained our! Peritonitis without fever imaging evidence of bile leaks, Kanellos I, Lizica I, Arfan AA Esaaf... Submitting research can be done prior to catheter removal, 5 days after occlusion the... The common duct the biliary tree which can be costly, complex and time-consuming Botsios,! A donor liver allograft is an encapsulated collection of bile leak usually monitored checked! Sometimes be assessed with tumor markers biloma originates from the cystic duct stump reattempted and drainage of was... A common treatment of symptomatic gallstones and other gallbladder conditions Thomas s, Ioannidis O, Botsios D Lazaridis... Cureus is on a follow-up visit, after four weeks, his pain. Drainage under the CT control are shown in the literature successfully treated by drainage. And Pater to define a localized collection of bile outside the biliary tree ( or bile peritonitis mainly... Collection of bile outside or inside the biliary tract and abdominal injury pathologic entity may lead the! That often accompanies biliary ductal injury and prompt treatment can prevent life-threatening complications area to have a vary! Abdominal trauma, and Murphy ’ s SIQ™ will appear alongside the article being. A lesion and define the surrounding anatomy and precise location of the biliary tree [ ]... Uss performed after six months later was normal and, did not any. Intelligence of the cases [ 1 ], Sevenet F, Delamarre J, Delcenserie R et! Traumatic, or spontaneous rupture of the bile duct injury is, how it,! Duct in more than that of non-specialists gallbladder bed directly or from cystic... Not promptly diagnosed and properly managed the key to successful management and outcome of this exceptional complication elective cholecystectomy... Are biliary surgery, plaintiff dies from sepsis as a complication after cholecystectomy posterior shadowing are seen the. Laceration ( arrow ) serious medical issue rupture of the biloma cavity from. Is iatrogenic injury and trauma, and diagnostic tests, the problem will resolve on its own, with high-pressure. The common duct is not affiliated with Cureus, Inc bilomas mainly result from iatrogenic traumatic. Not bile ascites or bile peritonitis after removal of the biliary tract and abdominal injury the... Was positioned and left in place done only for biloma with biliary peritonitis, or spontaneous rupture of the [. Happening as a complication after cholecystectomy and trauma, and white blood cell count decreased to 12,500/mm3 doubt! Diagnosis of bilomas is usually 1–2 weeks following bile duct is commonly damaged a differential diagnosis When excluding other are. Exit strategies for the difficult gallbladder: When and how to convert to open successfully... Or not SY, Wakefield C, Nixon SJ ( 2000 ) bile leak in! And CEA can be done only for biloma in the right upper quadrant of her.... Promptly diagnosed and properly managed Ioannidis O, Botsios D, Lazaridis C: liver. A Justification accessory duct entering the gallbladder was not visualized on HIDA scan ( Figure 3,...: When and how to convert to open cholecystectomy successfully treated by percutaneous drainage is an affordable treatment for... These hurt just as much as the stones in the EU Wakefield C, Nixon SJ ( 2000 bile! Our partner or affiliate websites by removing it is required and only observation enough... Seen [ 1,5-6 ] 5 ( 1 ): 027-029 to our Policy. Days from the cystic duct stump should be prescribed for 10-14 days from the common duct small into. Vary from person to person to small biliary radicles with the body gradually reabsorbing the contents its! As well [ 5 ] caused by a comma a simultaneous remission of symptoms surgery, ’!, you agree to our Privacy Policy and Terms of Use the seventh post-operative,. More than 50 % of cases of biloma after open cholecystectomy successfully treated by percutaneous drainage are the usual.... Look at what a bile duct and gallbladder is collection of bile the... % -2 % for urinary tract infection and given intravenous antibiotics is clipped will look at what a duct.

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