PDF(Pubmed)
Abstract：
UNASSIGNED: Biloma is an uncommon form of liver abscess composed of bile usually associated with procedures of the biliary tree and gallbladder. Cholangitis can be acute or chronic, can result in partial or complete obstruction of the flow of bile. The infection of the bile is so common, that positive blood cultures are highly characteristic. In the case of a suppurative cholangitis with signs of sepsis treatment alone with antibiotics is usually not sufficient to achieve medical remission. Multiple hepatic abscesses are often present, and the mortality approaches 100% unless prompt endoscopic or surgical relief of the obstruction and drainage of infected bile are carried out. Endoscopic retrograde cholangiopancreatography ERCP with endoscopic sphincterotomy is the preferred initial procedure for both establishing a definitive diagnosis and providing effective therapy.
UNASSIGNED: We present the case of a 69-year-old female patient with complex chronic comorbidities who presented with acute cholangitis initially managed with endoscopically inserted stent and later complicated by sepsis and biloma formation. The bile was drained, and it showed an infection with Candida spp. requiring antifungal therapy.
UNASSIGNED: The failure to perform sphincterotomy in patients with suppurative cholangitis can contribute to the backflow of bile and worse outcomes.
CONCLUSIONS: Biloma formation is a rare complication of biliary duct procedures and diseases such as cholangitis. A prompt identification of signs of complications in patients with disease of the biliary ducts is key in preventing clinical deterioration.Sphincterotomy is vital in the management of ascending cholangitis, as it prevents backflow of bile into the intrahepatic biliary system.The presence of multiple comorbidities in complex cases can become an obstacle to optimal management and drainage of septic bile.
UNASSIGNED: We present the case of a 69-year-old female patient with complex chronic comorbidities who presented with acute cholangitis initially managed with endoscopically inserted stent and later complicated by sepsis and biloma formation. The bile was drained, and it showed an infection with Candida spp. requiring antifungal therapy.
UNASSIGNED: The failure to perform sphincterotomy in patients with suppurative cholangitis can contribute to the backflow of bile and worse outcomes.
CONCLUSIONS: Biloma formation is a rare complication of biliary duct procedures and diseases such as cholangitis. A prompt identification of signs of complications in patients with disease of the biliary ducts is key in preventing clinical deterioration.Sphincterotomy is vital in the management of ascending cholangitis, as it prevents backflow of bile into the intrahepatic biliary system.The presence of multiple comorbidities in complex cases can become an obstacle to optimal management and drainage of septic bile.
摘要：
■Biloma是一种罕见的肝脓肿，由胆汁组成，通常与胆道和胆囊的手术有关。胆管炎可以是急性或慢性的，可导致胆汁流动的部分或完全阻塞。胆汁的感染非常普遍，血培养阳性是很有特点的.在化脓性胆管炎的情况下，仅使用抗生素治疗败血症的迹象通常不足以实现医学缓解。多发肝脓肿常出现，除非及时进行内镜或手术解除梗阻和引流感染胆汁，否则死亡率接近100%。内镜逆行胰胆管造影ERCP与内镜括约肌切开术是建立明确诊断和提供有效治疗的首选初始程序。
■我们介绍了一名69岁女性患者的病例，该患者患有复杂的慢性合并症，最初通过内窥镜插入支架治疗急性胆管炎，后来并发败血症和胆汁瘤形成。胆汁被抽干了,显示念珠菌感染.需要抗真菌治疗.
■化脓性胆管炎患者未能进行括约肌切开术可导致胆汁回流和不良预后。
结论：Biloma形成是胆道手术和胆管炎等疾病的罕见并发症。迅速识别胆道疾病患者的并发症迹象是防止临床恶化的关键。括约肌切开术在上行性胆管炎的治疗中至关重要，因为它可以防止胆汁回流到肝内胆道系统。在复杂情况下，多种合并症的存在可能成为脓毒性胆汁的最佳管理和引流的障碍。
■我们介绍了一名69岁女性患者的病例，该患者患有复杂的慢性合并症，最初通过内窥镜插入支架治疗急性胆管炎，后来并发败血症和胆汁瘤形成。胆汁被抽干了,显示念珠菌感染.需要抗真菌治疗.
■化脓性胆管炎患者未能进行括约肌切开术可导致胆汁回流和不良预后。
结论：Biloma形成是胆道手术和胆管炎等疾病的罕见并发症。迅速识别胆道疾病患者的并发症迹象是防止临床恶化的关键。括约肌切开术在上行性胆管炎的治疗中至关重要，因为它可以防止胆汁回流到肝内胆道系统。在复杂情况下，多种合并症的存在可能成为脓毒性胆汁的最佳管理和引流的障碍。
