A case report of a spontaneous biloma growing rapidly with infection

We report a case of a spontaneous biloma associated with an incarcerated confluence stone. A 74-year-old man was admitted to our hospital because of upper abdominal pain, jaundice, and fever. Abdominal MRI performed in the morning of the admission day showed no specific findings. But, about 5 hours later on the same day, abdominal CT and ultrasonography revealed large cystic lesions located on the anterior and posterior surfaces of the left lobe of the liver. Since aspirated fluid revealed bile infected with Klebsiella pneumoniae, the lesions were diagnosed as bilomas with infection. We could not find any previous report on such a rapid-growing biloma following obstruction of the bile duct with a confluence stone. A biloma is usually slow-growing. Our rare case suggests that we should conduct CT or ultrasonography repeatedly to detect the possibility of bile duct obstruction when we find a rapidgrowing biloma.