Most cases of biloma are caused by liver trauma or surgical intervention. However, spontaneous cases have been reported. We present a patient with spontaneous biloma which may have developed secondary to stenosis of the common bile duct or infarction of the liver. The initial treatment was percutaneous drainage, followed by ERCP with papillotomy and stenting of the common bile duct. Despite this therapy symptoms recurred and the patient had to undergo resection of a liver segment. The treatment of biloma in general is discussed.