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Description

A patient who has had a liver transplant may develop an infected "biloma". Safdar et al identified risk factors for mortality and need for surgical management in these patients. The authors are from the University of Wisconsin.


 

Features of a biloma:

(1) intrahepatic or parahepatic fluid collection rich in bile

(2) typically associated with bile leak, often at an anastomotic site

 

Differential diagnosis:

(1) hematoma

(2) abscess

 

Clinical findings in patients with an infected biloma:

(1) fever

(2) abdominal pain

(3) elevated liver function tests

The authors found that a third of patients were asymptomatic, so a high index of suspicion is needed to make the diagnosis.

 

Risk factors for mortality include:

(1) pre-transplantation renal insufficiency (odds ratio 12.5)

(2) infection with Candida species (odds ratio 4.9)

(3) infection with Gram negative bacteria (odds ratio 9.1)

 

In the spreadsheet a score is used giving 3 points for renal insufficiency, 2 for Gram-negative bacteria, and 1 for Candida.

 

Risk factors indicating a need for surgical management - one or more of the following:

(1) presence of hepatic artery thrombosis

(2) infection with Candida species

(3) infection with Enterococcus species

 


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