Abstract
While conservatively treating a blunt liver injury we encountered a case of intrahepatic biloma that was compressing the patient's inferior vena cava (IVC). The 20-year-old Japanese male fell from a height of 1 m to the floor, hitting his face and chest. He was diagnosed with a fractured zygomatic bone and then released. However, persistent right hypochondralgia brought him back to our hospital for further examination on the 17th day after injury. A contrast-enhanced abdominal CT revealed liver injury (S5,7,8 JAST Ib, OIS Grade III), an IVC showing a flattened shape, and a low density area surrounding the portal vein and the gallbladder. On the 40th day after injury he complained of dizziness while walking and went into shock. The biloma was drained percutaneously of approximately 1,200 mL of fluid that contained bile. IVC flatness and the periportal low density area had disappeared from a CT obtained on the following day. The exact cause of shock was not determined; however, it is possible that compression of the IVC by the biloma have decreased venous return. The possibility of compression of the IVC by the biloma should be considered during the treatment of blunt liver injury.
