Cholangitis and Liver Abscess after Percutaneous Ablation Therapy for Liver Tumors: Incidence and Risk Factors

Shibata, Toshiya; Yamamoto, Yūzō; Yamamoto, Naoki; Maetani, Yoji; Shibata, Toshinobu; Ikai, Iwao; Terajima, Hiroaki; Hatano, Etsuro; Kubo, Takeshi; Itoh, Kyo; Hiraoka, Masahiro

doi:10.1097/01.rvi.0000099532.29957.4f

Cited by 99 publications

(78 citation statements)

References 27 publications

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“…The most frequent organisms found in these abscesses were Enterococcus, E. coli, Bacteroides fragilis, E. faecalis, C. perfringens and Klebsiella pneumonia [5,21,23] . The best treatment option is percutaneous drainage in combination with systemic antibiotics [19][20][21]24] .…”

Section: Infectionmentioning

confidence: 99%

“…This group of complications consists of hepatic abscess, wound infection and sepsis. Hepatic abscess is a potentially dangerous complication with an incidence ranging in the literature from 0.3% to 1.7% [6,9,11,12,[21][22][23] . It can appear up to more than 60 d after the procedure [23] .…”

Section: Infectionmentioning

confidence: 99%

“…The best treatment option is percutaneous drainage in combination with systemic antibiotics [19][20][21]24] . Early suspicion, diagnosis and treatment are essential for a good outcome so the physician should be alert to the patient's clinical follow up, especially in those with risk factors.…”

Section: Infectionmentioning

confidence: 99%

“…These strictures are believed to lead to liver atrophy and its consequent malfunction [25] . This is very important for cirrhotic patients because, due to their already impaired liver function, they may easily develop liver failure and cholangitis after bile duct stenosis [21,25] . Cholestasis and biliary infection may also occur.…”

Section: Biliary Tract Damagementioning

confidence: 99%

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Complications of radiofrequency ablation of hepatic tumors: Frequency and risk factors

Fonseca

Santin

Gomes

et al. 2014

WJH

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Radiofrequency ablation (RFA) has become an important option in the therapy of primary and secondary hepatic tumors. Surgical resection is still the best treatment option, but only a few of these patients are candidates for surgery: multilobar disease, insufficient liver reserve that will lead to liver failure after resection, extra-hepatic disease, proximity to major bile ducts and vessels, and co-morbidities. RFA has a low mortality and morbidity rate and is considered to be safe. Thus, complications occur and vary widely in the literature. Complications are caused by thermal damage, direct needle injury, infection and the patient's co-morbidities. Tumor type, type of approach, number of lesions, tumor localization, underlying hepatic disease, the physician's experience, associated hepatic resection and lesion size have been described as factors significantly associated with complications. The physician in charge should promptly recognize high-risk patients more susceptible to complications, perform a close post procedure follow-up and manage them early and adequately if they occur. We aim to describe complications from RFA of hepatic tumors and their risk factors, as well as a few techniques to avoid them. This way, others can decrease their morbidity rates with better outcomes.

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Section: Infectionmentioning

confidence: 99%

Section: Infectionmentioning

confidence: 99%

Section: Infectionmentioning

confidence: 99%

Section: Biliary Tract Damagementioning

confidence: 99%

See 2 more Smart Citations

Complications of radiofrequency ablation of hepatic tumors: Frequency and risk factors

Fonseca

Santin

Gomes

et al. 2014

WJH

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“…A follow-up positron emission tomography (PET) scan 2 years after presentation demonstrated only a solitary liver metastasis, for which RFA was performed under general anesthesia. Because of the presence of a biliary stent, preprocedure antibiotics were given as well as 3 weeks of oral treatment postprocedure [6,7].The tumor was located at the hepatic dome, immediately adjacent to the liver capsule and diaphragm. Because of the potential for diaphragmatic injury, a total of 1.0 L of D5W was instilled into the abdomen through a 20-gauge spinal needle prior to the RF procedure ( Fig.…”

mentioning

confidence: 99%

Thermal Protection with 5% Dextrose Solution Blanket During Radiofrequency Ablation

Chen

Neeman

Lee

et al. 2006

Cardiovasc Intervent Radiol

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A serious complication for any thermal radiofrequency ablation is thermal injury to adjacent structures, particularly the bowel, which can result in additional major surgery or death. Several methods using air, gas, fluid, or thermometry to protect adjacent structures from thermal injury have been reported. In the cases presented in this report, 5% dextrose water (D5W) was instilled to prevent injury to the bowel and diaphragm during radiofrequency ablation. Creating an Insulating envelope or moving organs with D5W might reduce risk for complications such as bowel perforation. Keywords Radiofrequency ablationAlthough complication rates during hepatic radiofrequency ablation (RFA) are quite low, catastrophic damage to the bowel is possible, and injury to the diaphragm or thoraco-abdominal wall can result in substantial postprocedure pain. In RFA of focal hepatic cancers, gastrointestinal wall perforation resulting from thermal injury is seen in 0.7% of cases [1]. This serious complication could result in further major surgery or death. Several methods have been described to protect adjacent structures from thermal damage by displacing organs with gas, fluid, balloons, or the use of thermometry [2][3][4][5]. Targeted instillation of 5% dextrose water (D5W) solution might provide insulation to minimize injury to sensitive anatomy, such as the bowel or nerves. D5W might be more efficacious than normal saline because it not only mechanically forms a protective insulating envelope but also has less electrical conductivity than normal saline. Less conductivity might result in less heat transfer to surrounding tissues. Therefore, we chose to use D5W instead of normal saline for the cases described below. Case 1The patient was a 32-year-old female with metastatic adrenocortical carcinoma, first diagnosed 3 year prior to presentation, at which time she underwent resection of primary adrenal neoplasm. Lung and retroperitoneal metastases developed 5 months later and she has since been stabilized with slowly progressive disease on multiple chemotherapeutic regimens. Although her extrahepatic disease remained well controlled on chemotherapy, two liver metastases appeared 3 months prior to RFA and rapidly progressed with growth markedly outpacing extrahepatic sites. Concurrent right upper quadrant pain was present. Magnetic resonance (MR) scan pre-RFA showed two liver lesions: one left lobe measuring 5.9 × 5.6 cm and the one right lobe lesion measuring 4.2 × 2.7 cm and whose inferior aspect touched the colon (Fig. 1A,B).Written informed consent was obtained and RFA was performed on an investigational reviewboard-approved study. Under general anesthesia and prior to RFA, a 22-gauge Chiba needle was inserted percutaneously under continuous ultrasound guidance in a lower intercostal space near the midaxillary line. The needle was placed at the liver capsule lateral to the right lobe. Thirty cubic centimeters of D5W was injected at the capsule until a target was seen on ultrasound for subsequent deployment of a side-hole s...

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Tumor Ablation: Interventional Management of Complications

2005

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Cholangitis and Liver Abscess after Percutaneous Ablation Therapy for Liver Tumors: Incidence and Risk Factors

Cited by 99 publications

References 27 publications

Complications of radiofrequency ablation of hepatic tumors: Frequency and risk factors

Complications of radiofrequency ablation of hepatic tumors: Frequency and risk factors

Thermal Protection with 5% Dextrose Solution Blanket During Radiofrequency Ablation

Tumor Ablation: Interventional Management of Complications

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