The term biloma describes a rare disease pattern of a cyst filled with bile. The diagnosis of a biloma is very rare, not only because it does not occur very often, but if it does it is not always symptomatic. The main reason for the occurrence of these cysts are iatrogenic: those can be due to liver and bile duct surgery as well as other interventions in this area like endoscopic examinations, radiofrequency ablation or chemoembolization. Other than that, trauma can cause a biloma. The occurrence of a spontaneous biloma is extremely rare. There is a difference between non-symptomatic and symptomatic bilomas. The former are often self-limited and there is no need for treatment. Infected bilomas in contrast, should be treated fast and focused. As there is no general definition of the term biloma, it is difficult to compare existing studies. In anglophone literature reviews about bilomas do not exist. General criteria about diagnosis and treatment are not yet established. All these points illustrate that further studies are needed. The present survey with 32 patients is an important contribution in this context. Other studies with a higher number of patients including different causes and different treatments of biloma could not be found. No data dealing with bacterial colonization of infected bilomas was found in released literature. This study at hand presents aerobe gram-negative bacteria as the main part with 43,0%. The aerobe gram-positive germs amount to 32,2%. These results correlate with the bacterial colonization of the bile in patients with acute cholangitis. The antibiotic treatment should consequently follow the same criteria, as long as there is no culture of the bile including tested resistances of the bacteria present. Concerning the treatment, several facts should be considered. Important parameters are size, localization, underlying disease and the general state of health. Options for treatment are endoscopic (ERC) or percutaneous interventions as the PTCD, sonographic- or computer-tomographic-guided punctures or surgery. Several patients were treated with more than one method. One aim of this survey, the comparison of how effective the different treatments are, can hardly be evaluated. There are two main reasons: On the one hand, the combination of the treatments created twelve groups, five groups maintain one single patient. On the other hand, the group of the patients is too different regarding known previous illness and general condition, making it difficult to compare the outcome. A fact is, that non-surgical treatment was sufficient for 96,9% of the patients. The rate of regression in the group “wait and see” (21,9%) is 80,0%, in the group of the interventional treated patients (78,1%) 78,3%. It definitely needs to be determined a general definition of the term biloma. Furthermore other studies with a prospektiv, randomised design need to be realized.
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The term biloma describes a rare disease pattern of a cyst filled with bile. The diagnosis of a biloma is very rare, not only because it does not occur very often, but if it does it is not always symptomatic. The main reason for the occurrence of these cysts are iatrogenic: those can be due to liver and bile duct surgery as well as other interventions in this area like endoscopic examinations, radiofrequency ablation or chemoembolization. Other than that, trauma can cause a biloma. The occurrenc...
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