Huge biloma after endoscopic retrograde cholangiopancreatography and endoscopic biliary sphincterotomy

• The physical fitness of the patient for general anaesthesia was not very good, and the patient developed cardiac arrhythmia during the operation, obliging the surgeon to work quickly, possibly leading a thermal overshooting injury to the CBD that caused stricture.
• The patient lived in a city with simple medical facilities, explaining why he did the surgery in another city, the ERCP was performed in a 3rd city, and the final management was performed in a 4th city. Because of the war circumstances, we do not have a city with full medical services in Iraq, placing a burden on the patient as well as on the medical staff to complete the job properly. All of these complicating situations are due to the poor living conditions and security situations in Iraq.
• Significant medical complications may be resolved by simple procedures and minimal surgical interventions using simple tools that may save the life of the patient.

BackgroundBiliary leak can occur as a complication of biliary surgery, endoscopic retrograde cholangiopancreatography manipulations and endoscopic biliary sphincterotomy. Consequently, bile may collect in the abdominal cavity, a condition called biloma. Rarely, it may reach a massive size.Case presentationA 72-year-old man presented with gastric upset with gradual abdominal distension reaching a large size due to intra-abdominal bile collection (biloma) after endoscopic retrograde cholangiopancreatography plus endoscopic biliary sphincterotomy and stenting for post laparoscopic cholecystectomy common bile duct stricture. This huge biloma was treated by percutaneous insertion of a tube drain for a few days, evacuating the collection successfully without recurrence.DiscussionThis patient might sustain injury to the common bile duct either by the guide wire or stent, or the injury occurred at the angle between the common bile duct and duodenum during sphincterotomy of the ampulla. Although any of these rents may lead to a bile leak, causing a huge biloma, they could be successfully treated by percutaneous drainage.Conclusions(1) Following endoscopic retrograde cholangiopancreatography, a patient’s complaints should not be ignored. (2) A massive biloma can occur due to such procedures. (3) Conservative treatment with minimal invasive technique can prove to be effective.