Hepato-pericardial fistula following radiofrequency ablation (RFA) for liver metastasis: a case report and review of the literature.
BACKGROUND
Recent large-scale studies have demonstrated the efficiency and safety of radiofrequency ablation (RFA) for unresectable hepatic tumors. Nevertheless, severe side effects especially relating to non-target thermal injury have occurred after radiofrequency ablation.


METHODS
We observed the development of a hepato-pericardial fistula leading to pericardial empyema after RFA of a metastatic hepatic lesion. Concerning the genesis of the fistula, development from thermal damages in the diaphragm and pericardium as well as abscess formation in the liver is assumed. Treatment consisted of percutaneous drainage and flushing via remaining hepatic and pericardial catheters. Recovery was achieved conservatively after 2 months. To the best of our knowledge, a hepato-pericardial fistula as a complication of RFA has not been reported so far. The review of the literature revealed several cases of intrahepatic abscess formation after RFA as well as one case of pericardial empyema due to perforation of hepatic amoebic abscess. Two cases of pericardial tamponade after RFA are reported in the literature leading to death. Treatment via percutaneous drainage has been successful in this case and correlates with the successful treatment of abscess formation after RFA of metastatic pancreatic cancer. Other authors suggest pericardectomy or thoracotomy in the treatment of pericardial empyema.


CONCLUSIONS
The management of hepatic abscess formation subsequent to RFA of metastatic hepatic malignancies is not well described. We regard the percutaneous drainage as treatment of pericardial empyema as well as hepatic abscess as less invasive and sufficient, as demonstrated in this case.
Thiemann
Max
M
Department of General and Visceral Surgery, Center of Minimally Invasive Surgery, HELIOS Klinikum Berlin-Buch, Berlin, Germany.
Benhidjeb
Tahar
T
Anders
Stefan
S
Gebauer
Bernhard
B
Strik
Martin W
MW
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D003131:Combined Modality Therapy; D004322:Drainage; D004564:Electrocoagulation / Q000295:instrumentation*; D005402:Fistula / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005706:Gallbladder Neoplasms / Q000175:diagnosis / Q000601:surgery*; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008100:Liver Abscess / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D008107:Liver Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D018365:Neoplasm, Residual / Q000601:surgery; D010490:Pericardial Effusion / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D010496:Pericardium / Q000473:pathology; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D012086:Reoperation; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents