Unnoticed biloma due to liver puncture after Veress needle insertion

Laparoscopic surgery has become more widespread in the last years. Creating the pneumoperitoneum is the first surgical procedure but it is still responsible for many of the adverse events described in this field. Until now, liver puncture producing a delayed biloma has not been described. We present a case where a biloma was developed after liver puncture by the Veress needle, during a laparoscopic procedure, and detected on the 3rd day. It was detected by CT scan and treated by laparoscopy. Biloma due to Veress needle is a new entity in the context of adverse events related to Veress needle insertion, which needs a high suspicious index. We recommend to do Palmer's test and to check the insertion and to look for possible lesions below with the camera in order to minimize incidence of such injuries. Should this happen, laparoscopic or percutaneous drainage are both suitable alternatives to solve this complication.
Highlights • Laparoscopic pneumoperitoneum is still a technique associated to complications. • Veress needle may injury biliary conducts during entry that can be unnoticed due to absence of bleeding. • Safety tests are recommended in order to reduce complications. • Should unnoticed biloma happens, laparoscopic approach is safe and effective.