BILOMA

A 59-year-old male patient with a history of smoking and alcohol consumption presented with progressive jaundice, tea-coloured urine, clay-coloured stools, and significant weight loss Laboratory tests revealed elevated liver enzymes, bilirubin, and C-reactive protein. A thoracoabdominal CT scan showed a dilated biliary tract and a solid mass in the biliopancreatic junction, while a cholangiopancreatography MRI showed a double duct sign. EUS-FNA and ERCP were performed to establish a conclusive diagnosis and decompress the biliary tract, but the cytopathological evaluation was nonconclusive. Ten days after the procedure, the patient developed a fever and abdominal pain. A clinical exam revealed a thickening in his right flank with signs of peritoneal irritation associated with a biological inflammatory syndrome. For further analysis, abdominal CT was performed (Figure 1). The chemical analysis showed the presence of bile pigment and bile salts.