Duodenopleural fistula formation after percutaneous radiofrequency ablation for recurrent hepatocellular carcinoma.
Radiofrequency ablation (RFA) is a treatment option in the management of unresectable or recurrent hepatocellular carcinoma (HCC). It can be performed either through laparotomy or in a minimally invasive manner by percutaneous, laparoscopic or thoracoscopic routes. Percutaneous RFA is associated with reduced surgical trauma and thus can be performed in patients with significant comorbidities. The procedure can be repeated after short intervals for sequential ablation of multiple liver lesions. However, the associated risks should not be underestimated. This is the first report of a rare complication of duodeno-pleural fistula after percutaneous RFA of a recurrent subcapsular HCC. The risk of bowel perforation during the ablation of subcapsular HCC requires special attention, since only the position of the tip of the electrode, but not the zone of ablation, can be assessed accurately by imaging during the procedure. Our case demonstrated that there was leakage of bowel content from the duodenal injury site into the pleural cavity through the RFA track. Subsequent uncontrolled infection resulted in empyema thoracis and led to the death of the patient.
Chan
Fion S
FS
Centre for the Study of Liver Disease, and Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong SAR.
Ng
Kelvin K
KK
Poon
Ronnie T
RT
Yuen
Jimmy
J
Tso
Wai Kuen
WK
Fan
Sheung Tat
ST
D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D004378:Duodenal Diseases / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology*; D008113:Liver Neoplasms / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D010995:Pleural Diseases / Q000209:etiology*; D016156:Respiratory Tract Fistula / Q000209:etiology*