Intrahepatic biloma following transcatheter arterial chemoembolization for hepatocellular carcinoma: Incidence, imaging features and management

Abstract

Abstract. Repeat transcatheter arterial chemoembolization (TACE) becomes more challenging for patients with intrahepatic biloma following TACE for hepatocellular carcinoma (HCC).The purpose of this study was to investigate the clinical course, incidence, imaging features and outcome and to explore the reasonable therapy scheme for intrahepatic biloma following TACE for HCC.A total of 4,695 TACE procedures were performed for 1,923 patients with HCC. Twenty patients with intrahepatic biloma following TACE were studied retrospectively. The incidence of intrahepatic biloma was 1.04% in this study. The 20 patients underwent 55 TACE procedures (mean, 2.75). Portal vein invasion was found in half of the patients. Eleven patients developed round solitary or multiple cystic biloma, 6 patients had branched biloma and 3 patients developed both cystic and branched biloma. Percutaneous drainage was applied for 4 patients. One patient underwent partial hepatectomy and one mortality occurred due to progressive biloma and multiple organ failure. Although severe intrahepatic biloma following TACE is rare, the procedure should be performed with caution. Timely and appropriate management, including percutaneous drainage, partial hepatectomy and antibiotic administration should be performed in the case of any signs of infection.

A Case of Candidal Infection of Large Biloma After CT-Guided Liver Biopsy Confirming Autoimmune Hepatitis

“…Disruptions or injuries are often secondary to laparoscopic cholecystectomies, post-Billroth II procedures, poor revision to the cystic duct stump, or puncturing the accessory ducts of Luschka. Other causes include blunt trauma to the abdomen, radiofrequency ablation or resection of hepatocellular carcinoma, and, rarely, spontaneous formation of bilomas secondary to an obstruction or rupture within the biliary system ( Table 1) [1][2][3][4][5][6][7][8].…”

“…Its limitations in identifying the exact point of leak due to poor demonstration of detailed anatomy can be circumvented with the concurrent use of a hybrid single-photon emission computed tomography (SPECT/CT) or magnetic resonance cholangiopancreatography (MRCP), which provide a more detailed depiction of the origin of leak showing points of connection between the biloma and the biliary system with an exactness of 79%-85% [11]. More invasive methods, such as ERCP, can also identify and simultaneously treat bilomas [1][2][3]. They must be distinguished from differentials such as pseudocysts, seromas, abscess, or hematomas [12].…”

“…An ultrasound (US) or CT afterwards is necessary to confirm that the biloma had drained. If still persistent, an ERCP to decompress, drain, and stent the biloma in combination with a PTC or surgical resection of the liver with biloma are options once the patient is no longer septic ( Figure 5) [1][2][3].…”

Pathophysiology and Imaging Findings of Bile Duct Necrosis: A Rare but Serious Complication of Transarterial Therapy for Liver Tumors

“…In the case of retrograde infection from the gastrointestinal tract, the BDN site and/or biloma become a liver abscess, which may result in lethal sepsis [ 10 , 11 , 12 ].…”

“…Progression of BDN causes peribiliary tissue necrosis and eventually induces biloma formation [ 8 , 9 ]. If biloma infection occurs by ascending cholangitis, it can form a liver abscess and cause severe sepsis or even death [ 10 , 11 , 12 ].…”