Abstract
BackgroundBilomas are defined collections of bile fluids mainly caused by iatrogenic injuries of the bile duct system. Owing to the infrequency of this disease, studies addressing bilomas are rare.MethodsBy using an endoscopic database, this retrospective study identified 32 patients with bilomas treated between 2004 to 2015, in order to analyse aetiology, clinical presentation, spectrum of pathogens, and resolution rate of bilomas.Results65.6% of the study population (21/32) developed bilomas after surgery and 21.9% (7/32) after endoscopic retrograde cholangiography (ERC). Icterus, fever, and abdominal pain were the leading symptoms. 93.9% (46/49) of microbiological bile cultures revealed a positive microbiology. The predominant microorganisms were the group of Enterobacteriaceae (43.0%, 52/121), followed by Enterococcus spp. (32.2%, 39/121), and Candida spp. (9.1%, 11/121). Multiresistant bacteria like Enterobacteriaceae were isolated from one quarter of all patients. Single or multimodal treatment resulted in an overall complication rate of 4.8% (9/188). Clinical follow-up analysis showed a complete resolution rate of 78.3% for interventional therapy and 80% in the non-interventional group.ConclusionsPathogen spectrum of bilomas mainly comprises the group of Enterobacteriacae and Enterococcus spp., with a high proportion of multiresistant bacteria. Different interventional approaches are available for biloma drainage, which seem to be safe and effective for most patients.Trial registrationGerman Clinical Trials Register DRKS00015208, retrospectively registered.
Highlights
Bilomas are defined collections of bile fluids mainly caused by iatrogenic injuries of the bile duct system
Biliary leakages of the bile duct often close spontaneously, major leakages may result in bilomas [2]
Antibiotics in case of infection and drainage of bilomas, i.e. using percutaneous transhepatic cholangiodrainage, endoscopic retrograde cholangiography (ERC) or CT, or sonographic-guided puncture are the mainstay of treatment
Summary
Bilomas are defined collections of bile fluids mainly caused by iatrogenic injuries of the bile duct system. Bilomas are encapsulated intra- or extrahepatic collections of bile fluid caused by an injury of the bile duct resulting in biliary leakages. Biliary leakages of the bile duct often close spontaneously, major leakages may result in bilomas [2]. Genesis of biloma are mainly iatrogenic injury of the bile duct system [4], whereas spontaneous bilomas are very rare and mostly associated to choledocholithiasis [5]. The differentiation of bilomas from liver abscesses is challenging, abscesses are less caused by interventions and tend to be more encapsulated compared to bilomas [6].
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