title: Huge biloma after endoscopic retrograde cholangiopancreatography and endoscopic biliary sphincterotomy.
abstract: BACKGROUND
  Biliary 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.
  
  
  METHODS
  A 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.
  
  
  CONCLUSIONS
  This 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.
authors.affiliation: College of Medicine, Tikrit University, Iraq. Electronic address: khateeb_hm@yahoo.com.
authors.forename: Harith M
authors.initials: HM
authors.lastname: Alkhateeb
authors.affiliation: College of Medicine, Tikrit University, Iraq. Electronic address: thaere.jasim@yahoo.com.
authors.forename: Thaer J
authors.initials: TJ
authors.lastname: Aljanabi
authors.affiliation: Tikrit Teaching Hospital, Iraq. Electronic address: jaguar_fp@yahoo.com.
authors.forename: Khairallh H
authors.initials: KH
authors.lastname: Al-Azzawi
authors.affiliation: Kurdistan Center for Gastroenterology and Hepatology, Assulaymaniah, Kurdistan, Iraq. Electronic address: alkarbolytaha@gmail.com.
authors.forename: Taha A
authors.initials: TA
authors.lastname: Alkarboly
keywords: Biloma; Endoscopic retrograde cholangiopancreatography; Percutaneous drainage; Sphincterotomy