Kentaro Yoshioka

A 76-year-old man was admitted due to fever and general fatigue. He had undergone three sessions of repeated transcatheter arterial chemoembolization (TACE) with arterial infusion therapy using cisplatin for multiple hepatocellular carcinoma at our hospital. An abdominal CT scan showed a low density area surrounding the spleen. Since US guided drainage revealed that the low density area was filled with bile juice, we performed endoscopic retrograde cholangiopancreatography (ERCP), which showed choledocholithiasis and the leakage of contrast medium from the peripheral intrahepatic bile duct to the extrahepatic area surrounding the spleen. Thus a diagnosis of an extrahepatic biloma surrounding the spleen was made, and an endoscopic biliary drainage (EBD) tube was placed. The biloma rapidly decreased. When endoscopic sphincterotomy (EST) and removal of the bile duct stone were performed after two weeks, ERCP showed no leakage of bile juice to the extrahepatic area. ERCP and EBD were useful for the diagnosis and treatment of an extrahepatic biloma surrounding the spleen.