Transpapillary/Transfistular Drainage for Two Refractory Postoperative Right‐Lobe Bilomas: A Case Report

ABSTRACT We report a case of two refractory postoperative right‐lobe bilomas that were successfully treated with transpapillary/transfistular (TP/TF) drainage. A 57‐year‐old man developed two bilomas (segments 6 and 7) after repeated hepatectomy for colorectal liver metastases. Initial endoscopic retrograde cholangiopancreatography with endoscopic nasobiliary drainage (ENBD) was performed; however, biloma enlargement was observed despite ENBD placement, prompting a switch to TP/TF drainage. Two 5‐Fr pigtail‐type ENBD tubes were placed within the biloma cavities, followed by internalization after confirmed biloma regression (B6: from 93 to 38 mm, B7: from 71 to 28 mm). As the leak improved from high‐grade to low‐grade, the drainage strategy was modified to plastic stent placement in the B7 bile duct, ultimately achieving complete biloma resolution approximately 8 months after TP/TF drainage. Stent‐free status has been maintained for 13 months, with a total follow‐up of 21 months. This case demonstrates that TP/TF drainage is a feasible and effective option for multiple right‐lobe bilomas, particularly when endoscopic ultrasound‐guided transmural drainage would require multiple transmural procedures, allowing endoscopic treatment to be completed without percutaneous drainage.