EUS-guided drainage of a 20-cm biloma by use of a lumen-apposing metal stent

摘要

With the advent of laparoscopic surgery, postoperativebile-duct injuries have become more common over thepast several decades. 1 Recent studies have suggested thatthe incidence of bile-duct injury resulting from laparo-scopic cholecystectomies ranges from 0.3% to 0.6%. 2Disruption of the biliary ductal anatomy can lead to intra-abdominal leakage of bile and the formation of a biloma.A biloma is defined as “any well-demarcated collection ofbile outside the biliary tree.” 3 If left untreated, bilomascan lead to significant morbidity and mortality. The rateof bile leakage can be slow or rapid, with the latterfrequently resulting in peritonitis. Slow leaks ofteninduce an inflammatory response leading to fibrosis andencapsulation of the fluid collection. 1 Although mostbilomas are diagnosed within days to weeks, some casereports have documented bilomas going unrecognizedfor years. 4 Traditionally, many bilomas were treated withpercutaneous drainage performed by an interventionalradiologist or surgeon. With the advancement inendoscopic techniques, EUS-guided drainage has emergedas a safe alternative for drainage of large intra-abdominalfluid collections.