Successful endoscopic treatment of huge infected biloma and hepatic abscess after endoscopic ultrasound-guided hepaticogastrostomy with brain abscess

Clin J Gastroenterol. 2022 Oct;15(5):988-993. doi: 10.1007/s12328-022-01659-9. Epub 2022 Jun 28.


A 77-year-old woman with obstructive jaundice due to pancreatic head tumor was admitted to our hospital for biliary drainage. Transpapillary biliary drainage was attempted using endoscopic retrograde cholangiopancreatography; however, the catheter could not be inserted into the bile duct. Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) was conducted using a 7-Fr plastic stent. Fever and cognitive dysfunction were observed 73 days after EUS-HGS. Abdominal-computed tomography (CT) showed a huge biloma and a liver abscess. On admission, an uncovered metal stent was applied to the biliary obstruction site of the distal bile duct using an antegrade stenting technique, and the plastic hepaticogastrostomy stent was substituted with a new one. On the second day, two double-pigtail plastic stents were inserted into the biloma, and one into the liver abscess. Head CT and magnetic resonance imaging revealed a brain abscess in the right cerebral frontal lobe. Serum white blood cell count and C-reactive protein level, and the state of consciousness, improved with antibiotic administration. Biloma and liver abscess almost disappeared on CT 38 days after admission. The brain abscess also improved, and the patient was discharged from the hospital 48 days after admission. Endoscopic ultrasound-guided biloma drainage is helpful because self-removal of the drainage tube and reduced activities of daily living are unlikely to occur.

Keywords: Biloma; Brain abscess; Endoscopic ultrasound-guided hepaticogastrostomy; Liver abscess.

Publication types

  • Case Reports

MeSH terms

  • Activities of Daily Living
  • Aged
  • Anti-Bacterial Agents
  • Brain Abscess* / complications
  • C-Reactive Protein
  • Cholangiopancreatography, Endoscopic Retrograde / adverse effects
  • Cholestasis* / etiology
  • Drainage / methods
  • Endosonography / methods
  • Female
  • Humans
  • Liver Abscess* / complications
  • Plastics
  • Stents / adverse effects
  • Ultrasonography, Interventional


  • Anti-Bacterial Agents
  • Plastics
  • C-Reactive Protein