Hepatic abscess with hepatobronchial fistula following percutaneous radiofrequency ablation for hepatocellular carcinoma: A case report

Dai, Huijuan; Cui, Dan; Li, Dawei; Zhai, Bo; Zhang, Jianjian; Zhang, Jianjun

doi:10.3892/ol.2015.3044

Cited by 12 publications

(12 citation statements)

References 15 publications

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“…In 1977, cases of bronchobiliary fistula and BPF were first reported during postoperative stricture of the bile duct (7). Many cases of hepatobronchial fistula caused by liver abscess, carcinoma, and parasites have been reported (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). By contrast, the case reported here was not associated with hepatobiliary disease.…”

Section: Discussionmentioning

confidence: 70%

Bronchopleural phrenic fistula caused by methicillin-resistant staphylococcus aureus pneumonia

Kang¹,

Kang²,

Min

et al. 2018

J. Thorac. Dis.

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Section: Discussionmentioning

confidence: 70%

Bronchopleural phrenic fistula caused by methicillin-resistant staphylococcus aureus pneumonia

Kang¹,

Kang²,

Min

et al. 2018

J. Thorac. Dis.

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“…Radiofrequency ablation is a minimally invasive and safe procedure that is extensively used for alleviating hepatic tumours. Only a few radiofrequency ablation‐induced cases of bronchobiliary fistula after treatment for hepatocellular carcinoma have been reported (Table ) . The possible causes have been indicated to be collateral thermal injury to the diaphragm, direct tumour invasion to the diaphragm, local infection after ablation, and biliary stricture after ablation.…”

Section: Discussionmentioning

confidence: 99%

Bronchobiliary fistula after radiofrequency ablation for hepatocellular carcinoma successfully treated by double drainage

Chang¹,

Lin²

2018

Respirology Case Reports

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For hepatocellular carcinomas, radiofrequency ablation is extensively used to alleviate primary and metastatic hepatic tumours. Common complications of this procedure include bleeding, infection, and hollow organ perforation. We present the case of a patient with hepatoma who underwent radiofrequency ablation. He had intractable cough with yellowish sputum, particularly while lying down, three weeks after treatment. Chest computed tomography demonstrated a right middle lobe consolidation with pleural effusion and right subphrenic fluid collection. Thoracoscopic decortication was performed under the diagnosis of empyema. The attending anaesthesiologist noted bile‐like fluid aspirated from the endotracheal tube. Therefore, we suspected bronchobiliary fistula. Percutaneous transhepatic drainage of the subphrenic fluid and simultaneous cholangiography confirmed bronchobiliary fistula. The patient was successfully treated using percutaneous drainage combined with endoscopic retrograde biliary drainage. An imaging finding of subphrenic fluid collection with right lower lung consolidation after radiofrequency ablation for hepatic tumours should raise the suspicion of bronchobiliary fistula.

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“…Subsequent investigations led to the discovery of a hepato-bronchial fistulization. The complication of hepatic-bronchial fistulae has been described as a rare complication of hepatic amebiasis [ 13 ], radiofrequency ablation for hepatocellular carcinoma [ 14 ], or as a surgical complication after cholecystectomy [ 15 ]. However, to the best of our knowledge hepatic-bronchial fistulization from ruptured hepatic abscess resultant from a chronic perforated sigmoid colon diverticulosis has not yet been reported.…”

Section: Discussionmentioning

confidence: 99%

Hepato-bronchial fistula secondary to perforated sigmoid diverticulitis: a case report

et al. 2017

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BackgroundPatients with diverticulitis are predisposed to hepatic abscesses via seeding through the portal circulation. Hepatic abscesses are well-documented sequelae of diverticulitis, however instances of progression to hepato-bronchial fistulization are rare. We present a case of diverticulitis associated with hepatic abscess leading to hepato-bronchial fistulization, which represents a novel disease course not yet reported in the literature.Case PresentationA 61-year-old Caucasian man presented with a history of unintentional weight loss and dyspnea both at rest and with exertion. He had a significant tobacco and alcohol misuse history. A massive right-sided pleural effusion was found on chest X-ray, which responded partially to chest tube insertion. A computed tomography scan of his thorax confirmed the presence of innumerable lung abscesses as well as a complex pleural effusion. An indeterminate tiny air pocket at the dome of the liver was also noted. A follow-up computed tomography scan of his abdomen revealed a decompressed hepatic abscess extending into the right pleural space and the right lower lobe. A sigmoid-rectal fistula was also revealed with focal colonic thickening, presumed to be the sequelae of remote or chronic diverticulitis. An interventional radiologist inserted a percutaneous drain into the decompressed hepatic abscess and the instillation of contrast revealed immediate filling of the right pleural space, lung parenchyma, and bronchial tree, confirming a hepato-bronchial fistula. After two concurrent chest tube insertions failed to drain the remaining pleural effusion completely, surgical lung decortication was conducted. Markedly thickened pleura were seen and a significant amount of gelatinous inflammatory material was debrided from the lower thoracic cavity. He recovered well and was discharged 10 days post-thoracotomy on oral antibiotics. The percutaneous liver abscess tube was removed 3 weeks post-discharge from hospital after the drain check revealed that the fistula and abscess had entirely resolved.ConclusionsRefractory right-sided pleural effusion combined with constitutional symptoms should alert clinicians to search for possible hepatic abscess, especially in the context of diverticulitis. The rupture of an untreated hepatic abscess could lead to death from profound sepsis or rarely, as in this case, a hepato-bronchial fistula. Timely investigation and a multidisciplinary treatment approach can lead to improved patient outcomes.

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Hepatic abscess with hepatobronchial fistula following percutaneous radiofrequency ablation for hepatocellular carcinoma: A case report

Cited by 12 publications

References 15 publications

Bronchopleural phrenic fistula caused by methicillin-resistant staphylococcus aureus pneumonia

Bronchopleural phrenic fistula caused by methicillin-resistant staphylococcus aureus pneumonia

Bronchobiliary fistula after radiofrequency ablation for hepatocellular carcinoma successfully treated by double drainage

Hepato-bronchial fistula secondary to perforated sigmoid diverticulitis: a case report

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