Biloma formation is encountered mainly after surgical or interventional procedures and trauma involving the biliary system [
2]. However, there are few reported cases of spontaneous biloma in the literature. The most frequent cause of spontaneous biloma is choledocholithiasis [
4,
5]. Less commonly reported causes include biliary tree malignancy, acute cholecystitis, hepatic infarction and abscess, obstructive jaundice and tuberculosis [
3‐
5]. Although the pathophysiology of spontaneous biloma remains to be elucidated [
5], one suggested contributing factor is an intraductal pressure increase due to obstructive lesions or infarctions on any part of the biliary tree [
4]. Bilomas are generally localized in the right upper quadrant of the abdomen, neighboring the right hepatic lobe [
4]. The clinical presentation of biloma varies greatly from nonspecific abdominal pain to biliary sepsis [
6]. Encapsulation of bile within the omentum and mesentery [
2] prevents generalized peritonitis in most cases. Abdominal US is the first modality to evaluate the nature of a biloma and the underlying pathology. However, an abdominal CT can define the disease, the cause and the relations with the adjacent structures more accurately [
3]. Differential diagnosis should include hematoma, seroma, liver abscess, cysts, pseudocysts, and lymphocele [
5]. Percutaneous aspiration under radiologic guidance can also aid in diagnosis and treatment. Biochemical and microbiological analysis of the fluid helps differentiation from pyogenic abscesses or other causes [
7]. An MRI may be of value to evaluate the etiology since it can be used safely for the pathologies of the biliary system [
8]. ERCP is also used for diagnostic and therapeutic purposes. Management of the biloma in a patient includes appropriate measures such as intravenous hydration and initiation of antibiotic treatment if sepsis is present. Although some bilomas, especially those that are small in size and asymptomatic, can be followed without intervention [
3], most require treatment. Percutaneous [
9] and endoscopic modalities provide adequate drainage and may be therapeutic in most cases [
6]. These treatments are preferable to surgery as the first step in treatment [
4,
5,
10]. ERCP is indicated particularly in treatment failure, such as persistent bile leakage despite percutaneous catheterization. Surgery always remains an option in emergency and persistent cases. In our patient, the biloma was located in the right upper quadrant and was detected with abdominal US. Because an MRI demonstrated CBD stones, ERCP was preferred for the first modality for diagnosis and treatment. Although it did not show the communication between the biliary tree and the collection and proved biloma, his CBD was cleared from stones. Repeat ERCP with stenting was necessary because the drainage didn't stop. In ERCP, the communication between the biliary tree and biloma was shown clearly, probably due to the decompression of the biloma by percutaneous drainage. The drainage ceased after five days. During our one year follow-up, there has been no recurrence by clinical or radiological means.