CHẨN ĐOÁN VÀ ĐIỀU TRỊ Ổ TỤ DỊCH MẬT TỰ PHÁT DƯỚI BAO GAN HIẾM GẶP (SPONTANEOUS INTRAHEPATIC BILOMA)

Abstract

Evaluation of clinical and paraclinical features of spontanous subhepatic biloma. 2. Result of treatment and review of literature. Results: + Male patient aged of 62 years old. + Medical history: Subtotal gastrectomy with D2 lymphadenectomy for gastric cancer in 2 previous month. + Admission for pain in right upper quadrant with fever (38 degree C). Physical examination reveal no mass subhepatic and epigastric area. + Abdominal ultrasound and CT.Scan showed mass measuring > 13 cm-6 cm subhepatic (right liver). - Magnetic resornant cholangiography (MRC) also reaveled biloma juxta and subhepatic (posterior and anterior segments) and reaveled no dilation and no stones intra or extrahepatic. However MRC showed biloma juxta biliary intrahepatic duct of posterior segment. Intervention was drainage under ultrasound  and the  volume of fluid aspirated was above 500-600 ml of bile. The drainage tube was left in place for 2 weeks and withdrew after ultrasound confirmation of the  residual volume of biloma mesuasing lower than 5cm and patient had no abdominal pain and no fever (symptoms free). Conclusion: Spontaneous intra hepatic  biloma is extreme rare condition. The diagnostic  methods are abdomial ultrasound, CT.Scan  (sensibility  and specificity of 90%) and magnetic resonance cholangiography (sensibility  and specificity of above 95%). Intervention is drainage under ultrasound or CT.Scan in association with antibiotic tharapy. If the bile  fistula persists, endoscopic sphinterostomy and bile duct stent could be indicated