Abstract
To discuss management of refractory bile leaks and present results instillation of gelfoam slurry in a single center experience.
From April 2012 to October 2013, five patients with bilomas refractory to conventional drainage have been treated by instillation of gelfoam slurry on separate occasions. Etiology of the initial bilomas included liver laceration, hepatic abscess, post surgical injury (2 cases,) and post ablation. Average age of the patients was 43 years (15-65 years.) all of whom were women. Initial management began with image guided drainage and placement of an APDL catheter. The patients presented for routine tube check/exchange and lavage during which the volume of the cavity was evaluated. Gelfoam and contrast were mixed to form a slurry in a volume just less than the cavity was instilled with fluoroscopic guidance. When possible, external drainage was converted to internal external drainage to promote resolution.
All five bilomas have resolved. On average they had been managed 155 days prior to instillation of gelfoam (15-310 days.) After instillation of gelfoam slurry which was performed on average 3 occasions (1-7 visits,) the time to resolution as on average 52 days (10-90 days.)
Bile leak and biloma formation are well-recognized complications of surgical and endoscopic hepatobiliary procedures. Conservative management with endoscopic or percutaneous techniques has become preferable in many of these cases to avoid surgical repair and its associated morbidity and mortality. Unfortunately, percutaneous transhepatic drainage can be a lengthy process subject to its own set of complications as well as significant patient discomfort. Initial results at our institution have demonstrated rapid reduction in biloma size on interval follow-up examinations and complete resolution of bilomas after instillation of gelfoam slurry.