We report a rare case of spontaneous biloma with a cancer of the common bile duct. A 71-year-old man was admitted to the hospital for further examination of fever up and obstructive jaundise. Abdominal computed tomography and ultrasonography revealed dilatated bile duct and ascites locarized in only left side of the abdomen which was from anterior wall of S3 area of the liver. Cholangiography at surgery showed complete obstruction at the lower common bile duct. Serum level of a tumor marker (CA19-9) was vary high. It was thought that the common bile duct cancer caused complete obstruction of the common bile duct to increase the pressure in the biliary tract which resulted in rupture and perforation of the intrahepatic bile duct causing spontaneous biloma. Drainage where PTCD tube was inserted into the perforated site and a T tube into the common bile duct was conducted.
In Japan, only 24 cases of biloma have been reported until 1996. Biloma with malignancy is very rare among of them.