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
