Long-term follow-up after non-operative management of biloma due to blunt liver injury

Abstract

Introduction: Some case series have reported that hepatectomy was used to treat major bile leakage and biloma. However, it is unknown whether non-operative management (NOM) can be used to treat these complications. Our hospital uses NOM primarily for blunt liver injuries. This study describes the incidence and treatment of newly developed biloma in hemodynamically stable patients with blunt liver trauma and investigates NOM as a treatment option.

Methods: A retrospective chart review was conducted from January 2006 to May 2012 at a tertiary care hospital in Japan. The primary outcome measures were the incidence of biloma and the number of patients who required operative management. Biloma was defined as a cystic lesion with low density near the site of liver injury on contrast-enhanced abdominal computed tomography.

Results: Chart review identified 98 patients (63 males and 35 females). Thirty-five of 98 patients (35.7 % [95 % CI, 26.2-45.2]) developed biloma. Infected biloma in three, of whom one required percutaneous drainage. Hepatectomy was not performed.

Conclusion: Our data suggest that biloma after NOM of blunt liver injury is common (36 %), but infected biloma is rare. All patients with bilomas were treated using NOM. Most bilomas are self-limited, and NOM is feasible.