Percutaneous embolization of refractory biliocutaneous fistula following radiofrequency ablation: A case report

Mei-Chen Chen, MD; Hsuen-En Hwang, MD; Nai-Chi Chiu, MD; Rheun-Chuan Lee, MD; I-Cheng Lee, MD, PhD; Chien-An Liu, MD

Radiology Case Reports (Nov 2023)

Percutaneous embolization of refractory biliocutaneous fistula following radiofrequency ablation: A case report

Mei-Chen Chen, MD,
Hsuen-En Hwang, MD,
Nai-Chi Chiu, MD,
Rheun-Chuan Lee, MD,
I-Cheng Lee, MD, PhD,
Chien-An Liu, MD

Affiliations

Mei-Chen Chen, MD: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
Hsuen-En Hwang, MD: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang Ming Chiao Tung University, Taiwan, ROC
Nai-Chi Chiu, MD: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang Ming Chiao Tung University, Taiwan, ROC
Rheun-Chuan Lee, MD: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang Ming Chiao Tung University, Taiwan, ROC
I-Cheng Lee, MD, PhD: School of Medicine, National Yang Ming Chiao Tung University, Taiwan, ROC; Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
Chien-An Liu, MD: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang Ming Chiao Tung University, Taiwan, ROC; Corresponding author.

Journal volume & issue: Vol. 18, no. 11
pp. 3787 – 3790

Abstract

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This case report presents a 73-year-old male with recurrent hepatocellular carcinoma who underwent serial surgical and interventional locoregional treatments, which resulted in asymptomatic intrahepatic bile duct dilatation. To address a recurrent tumor close to the pre-existing dilated bile ducts, radiofrequency ablation was performed, leading to a biliocutaneous fistula along the electrode tract. Attempts to close the refractory fistula by percutaneous transhepatic cholangial diversion and balloon dilatation of the stenotic central bile duct were unsuccessful. Ultimately, the fistula was successfully sealed with aggressive management, combining balloon-assisted retrograde fistulography and antegrade fistula embolization. This report aims to raise awareness of complex biliary complications after radiofrequency ablation in patients with preexisting bile duct dilatation, and emphasize the importance of aggressive intervention in cases of refractory biliocutaneous fistula based on our experience.

Published in Radiology Case Reports

ISSN: 1930-0433 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine
Website: https://www.sciencedirect.com/journal/radiology-case-reports

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