Clinical features and treatment of hepatic abscesses with biloma formation after transcatheter arterial chemoembolization

Manran Zhu; Guoping Li; Yi Chen; Gaoquan Gong; Weiqiang Guo

doi:10.1016/j.ajg.2021.12.002

Clinical features and treatment of hepatic abscesses with biloma formation after transcatheter arterial chemoembolization

Arab J Gastroenterol. 2022 Feb;23(1):32-38. doi: 10.1016/j.ajg.2021.12.002. Epub 2022 Feb 10.

Authors

Manran Zhu¹, Guoping Li², Yi Chen³, Gaoquan Gong³, Weiqiang Guo¹

Affiliations

¹ Department of Gastroenterology, Yuebei People's Hospital, Shaoguan, Guangdong 512025, China.
² Department of Interventional Therapy, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Institute of Medical Imaging, Shanghai 200032, China; National Clinical Research Center for Interventional Medicine, Shanghai 200032, China. Electronic address: gpli2001@163.com.
³ Department of Interventional Therapy, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Institute of Medical Imaging, Shanghai 200032, China; National Clinical Research Center for Interventional Medicine, Shanghai 200032, China.

PMID: 35153174
DOI: 10.1016/j.ajg.2021.12.002

Abstract

Background and study aims: A full understanding of the clinical manifestations and risk factors for hepatic abscesses with biloma formation after transcatheter arterial chemoembolization (TACE) is crucial for accurate diagnosis and effective therapeutic intervention.

Patients and methods: 11,524 patients with hepatic tumors were treated with TACE. 84 patients were diagnosed with hepatic abscesses after TACE, and 35 progressed to hepatic bilomas and were treated with percutaneous transhepatic drainage (PTD) and/or percutaneous transhepatic cholangiography and drainage (PTCD). Clinical features, blood samples, bacterial cultures, and imaging data were collected, and incidence, risk factors, therapeutic effects, and prognostic indicators were analyzed.

Results: The incidence of biloma in patients with liver abscesses was 41.7% with an average diagnosis time of 12.3 ± 3.2 days. 71.4% of patients complained of abdominal pain, and 63.7% had metastatic liver cancer. In the latter patients, clinical features included multiple abscess lesions with a poor blood supply to the tumor and large necrotic lesions. The original tumors were primarily in the digestive system (87.0%). The mean diameter of the largest lesions was 6.5 ± 2.3 cm. Before abscess formation, the Child-Pugh liver function classification was grade A in 14 cases and grade B in 21 cases. Escherichia coli was the most frequently seen infectious bacteria. Liver function was significantly compromised by the occurrence of hepatic abscesses. The mean survival time after diagnosis of liver abscesses in all patients was 11.5 ± 0.6 months. The causes of death included abscess (n = 9, 25.7%), tumor (n = 22, 62.9%), and other causes (n = 4, 11.4%). Risk factors included tumors, gastrointestinal surgery, and diabetes.

Conclusion: PTD and/or PTCD combined with active antibiotics are recommended as the first-line treatment and are effective therapeutic regimens for biloma formation after TACE.

Keywords: Biloma; Clinical features; Hepatic abscess; PTCD; Percutaneous transhepatic drainage; TACE; Transcatheter arterial chemoembolization.

MeSH terms

Carcinoma, Hepatocellular* / therapy
Chemoembolization, Therapeutic* / adverse effects
Humans
Liver Abscess* / diagnosis
Liver Abscess* / etiology
Liver Abscess* / therapy
Liver Neoplasms* / secondary
Liver Neoplasms* / therapy
Retrospective Studies