Conservative treatment of gastric perforation after microwave ablation of a hepatocellular carcinoma

Abstract

Rationale:Microwave ablation (MWA) has been proven to be an efficient and safe method for local tumor control of liver tumors. Reported complications are rare, but include liver abscess, hematoma, pleural effusion, and occasional thermal injury of the adjacent colon. Intestinal perforation usually requires immediate surgical treatment to prevent generalized peritonitis and sepsis.Patient concerns and diagnosis:Herein, we describe a case of gastric perforation following percutaneous MWA for hepatocellular carcinoma as a bridging therapy prior to liver transplantation.Interventions:Due to the clinical condition of the patient, conservative treatment was considered sufficient. Nine months after MWA, successful liver transplantation followed. Intraoperative findings revealed a scar in the gastric wall with tight adhesions to the liver, requiring adhesiolysis and subsequent suturing. Postoperative recovery was uneventful.Outcome:At present, the patient is doing well. No further gastrointestinal events occurred.Lesson:To our knowledge, this is the first report of such a complication occurring after MWA. Moreover, in this case, the gastric perforation could be treated conservatively.

Gastric Perforation After Microwave Ablation to Adjacent Hepatocellular Lesion

“…Owing to the absence of intraperitoneal gas or liquid and peritonitis, the patient was managed conservatively and had excellent clinical and radiographic outcomes. 10 It is evident that microwave ablation has brought about a shift in the paradigm of HCC management. The decision to use ablation therapy is typically individualized based on efficacy factors such as tumor size, patient health status, remaining liver function, and portal hypertension.…”

“…Owing to the absence of intraperitoneal gas or liquid and peritonitis, the patient was managed conservatively and had excellent clinical and radiographic outcomes. 10 …”