Biloma is a common complication in patients with traumatic liver injury. Biloma is usually confirmed by abdominal computed tomography (CT), and the first detection using abdominal ultrasonography is rare. We report a case of a patient with American Association for the Surgery of Trauma (AAST) grade IV liver injury according to the Organ Injury Scale (OIS) score, who underwent transcatheter arterial embolization on the day of admission and percutaneous drainage after the diagnosis of biloma on ultrasonography on day 5 after admission. In this case, biloma was observed as a hypoechoic to anechoic fluid collection in the hepatic dome on ultrasonography.
A 41-year-old man presented to the emergency department after a pedestrian traffic accident. The initial vital signs were unstable: systolic blood pressure, 80 mm Hg; pulse rate, 56 beats/min; respiration rate, 16 breaths/min; body temperature, 36.0℃; and oxygen saturation, 95%. Early abdominal computed tomography (CT) of the right side of the liver showed American Association for the Surgery of Trauma (AAST) grade IV injury, according to the Organ Injury Scale (OIS) score, with extravasation of contrast material (
CT and ultrasonography play an important role in the initial treatment of abdominal blunt trauma. CT has high sensitivity for detecting liver parenchymal injuries. However, it is difficult to rule out organ injuries on ultrasonography, even when performed by skilled technicians [
None of authors has a conflict of interest
Initial abdominal computed tomography, showing American Association for the Surgery of Trauma (AAST) grade II liver injury according to the Organ Injury Scale (OIS) score, with extravasation of contrast material in the right side of the liver.
Hepatic artery angiography, showing active bleeding in segments 5, 7, and 8 (A). Embolization was performed at the bleeding focus (B).
No extravasation of contrast material or biloma was observed on abdominal CT performed on day 3 after admission. The coils used for bleeding focus are visible.
On day 5 after admission, biloma (hypoechnoic to anechoic fluid collection) is observed in the hepatic dome on ultrasonography (A). Percutaneous drainage was performed (B).
Abdominal computed tomography 2 weeks after injury, showing biloma as a hypodense fluid collection. There is also drainage catheter in the biloma.