Delayed Biloma Secondary to an Iatrogenic Common Hepatic Duct Injury After Open Cholecystectomy: A Rare Cause of Persistent Biliary Drainage

Bilomas are localized collections of bile outside the biliary tree, most often resulting from an iatrogenic injury following hepatobiliary procedures. While bile leaks typically arise from the cystic duct stump and present early in the postoperative period, delayed biloma formation due to a proximal bile duct injury is uncommon. We report the case of a 35-year-old female who presented 52 days after open cholecystectomy with persistent bilious wound discharge, right upper quadrant pain, and intermittent jaundice. Abdominal ultrasonography revealed a subhepatic fluid collection communicating with the cystic duct stump, consistent with a biloma. Magnetic resonance cholangiopancreatography (MRCP) confirmed the biloma and demonstrated residual cystic duct calculi along with mild intrahepatic biliary dilatation. When conservative management failed, exploratory laparotomy revealed an iatrogenic injury to the common hepatic duct. A Roux-en-Y hepaticojejunostomy (RYHJ) was performed, leading to clinical improvement and resolution of the bile leak. At her two-week outpatient follow-up, the patient remained asymptomatic with normalized liver function tests. This case underscores the diagnostic challenge of delayed biloma secondary to a proximal bile duct injury and highlights the value of early imaging in guiding timely surgical management.