Clinical features and treatment of hepatic abscesses with biloma formation after transcatheter arterial chemoembolization |
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| Institution: | 1. Department of Gastroenterology, Yuebei People''s Hospital, Shaoguan, Guangdong 512025, China;2. Department of Interventional Therapy, Zhongshan Hospital, Fudan University, Shanghai 200032, China;3. Shanghai Institute of Medical Imaging, Shanghai 200032, China;4. National Clinical Research Center for Interventional Medicine, Shanghai 200032, China;1. Department of Tropical Medicine, Ain Shams Center for Organ Transplantation (ASCOT), Ain Shams University, Cairo, Egypt;2. Department of General Surgery, Ain Shams Center for Organ Transplantation (ASCOT), Ain Shams University, Cairo, Egypt;1. Department of General Surgery, Cerrahpasa Medical Faculty, ?stanbul University- Cerrahpasa, ?stanbul, Turkey;2. Department of Pathology, Cerrahpasa Medical Faculty, ?stanbul University- Cerrahpasa, ?stanbul, Turkey;1. Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt;2. Department of Microbial Biotechnology, Biotechnology Research Institute, National Research Centre, Giza, Egypt;3. Department of Pharmacy, Al-Mustaqbal University College, Babylon, Iraq;4. Clinical Pharmacy unit, Badr University Hospital, Helwan University, Egypt;1. Hepatology, Gastroenterology, and Infectious Diseases Department, Faculty of Medicine, Benha University, Benha, Egypt;2. Benha Fever Hospital, Benha, Egypt;3. Endemic Medicine and Hepato-gastroenterology Department, Faculty of Medicine, Cairo University, Egypt;4. Clinical and Chemical Pathology Department, Faculty of Medicine, Benha University, Benha, Egypt;5. Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Benha University, Benha, Egypt;1. Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Egypt;2. Department of Internal Medicine, Salem Medical Center and Center for Alcohol Research and Liver Disease, University of Heidelberg, Germany;3. Endemic Medicine and Hepato-gastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt;4. Gynecology and Obstetrics Department, Faculty of Medicine, Cairo University, Cairo, Egypt |
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| Abstract: | Background and study aimsA 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 methods11,524 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.ResultsThe 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.ConclusionPTD and/or PTCD combined with active antibiotics are recommended as the first-line treatment and are effective therapeutic regimens for biloma formation after TACE. |
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| Keywords: | Hepatic abscess Biloma Clinical features Transcatheter arterial chemoembolization TACE Percutaneous transhepatic drainage PTCD |
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