Cholecystitis with abdominal wall biloma after percutaneous transhepatic gallbladder aspiration: A case report. (2020)

• Record Type: Journal Article
• Authors: Toritani, Kenichiro; Sugita, Mitsutaka; Shimizu, Akiko; Watanabe, Akira; Ono, Hidetaka Andrew; Baba, Hiroyuki
• Is Part Of: International journal of surgery case reports. Volume 75(2020)
• Page Start: 276
• Page End: 278
• Publication Date: 2020
• Subjects: PTGBA percutaneous transhepatic gallbladder aspiration -- CRP C-reactive protein level -- CT computed tomography -- PTGBD percutaneous transhepatic gallbladder drainage; Abdominal wall biloma -- Case report -- Cholecystitis -- PTGBA; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2020.09.108
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: The complication of percutaneous transhepatic gallbladder aspiration. Inappropriate aspiration may cause an abdominal wall biloma. We should consider alternative therapy when aspiration was not sufficiently. Abstract: Background: Abdominal wall biloma is an uncommon entity. We herein report an extremely rare case of cholecystitis with abdominal wall biloma after percutaneous transhepatic gallbladder aspiration (PTGBA). Presentation of case: A 69-year-old woman was diagnosed with acute cholecystitis, and PTGBA was performed on Day 1. PTGBA was performed a second time because of re-expansion of the gallbladder and an increased CRP level on Day 3. Computed tomography was performed on Day 9 because we suspected recurrence of cholecystitis. It revealed a well-circumscribed fluid collection between the abdominal wall or the diaphragm and the liver. Based on these intraoperative findings, we diagnosed her with cholecystitis with abdominal wall biloma. Cholecystectomy and drainage of the abdominal wall biloma were performed on Day 10. The postoperative course was uneventful, and she was discharged on Day 18. Discussion: Early cholecystectomy is the gold-standard treatment for acute cholecystitis, but cholecystectomy is not performed in some cases. PTGBA is much more convenient, quicker, and less costly, but inappropriate aspiration during the second PTGBA session might have spread the infected bile to the abdominal wall through the PTGBA route. Conclusion: This case represents the first reported case of a biloma within the abdominal wall after PTGBA. To prevent this complication, we should aspirate gallbladder bile sufficiently during PTGBA. In addition, we should consider performing alternative therapy, such as percutaneous transhepatic gallbladder drainage or an operation, when we fail to appropriately aspirate.