Korean J Hepatobiliary Pancreat Surg.  2013 Aug;17(3):135-138. 10.14701/kjhbps.2013.17.3.135.

Surgical treatment of bronchobiliary fistula due to radiofrequency ablation for recurrent hepatocellular carcinoma

Affiliations
  • 1Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. dwchoi@skku.edu

Abstract

Bronchobiliary fistula (BBF) is a rare complication of radiofrequency ablation (RFA), in which there is abnormal communications between the biliary tract and the bronchial trees. Surgery should only be considered for BBF when non-invasive interventions have failed. In this report, we describe the surgical management for BBF when complicated by an abscess that was encountered after RFA in a 52-year-old woman with recurrent hepatocellular carcinoma (HCC). She had previously undergone central bisectionectomy of HCC 7 years ago, and had been treated with a sixth transarterial chemoembolization and first RFA for recurrent HCC after the operation. After the liver abscess and BBF occurred in the posterior section of the liver, she received posterior sectionectomy and hepaticojejunostomy, drainage of the lung abscess, diaphragmatic resection and repair because it was impossible to drain the abscess radiologically. Symptomatic improvements were being achieved through operative treatments where pleural effusion and pneumonic consolidation was obliterated on a 2-months follow-up image.

Keyword

Bronchobiliary fistula; Radiofrequency catheter ablation; Hepatocellular carcinoma; Hepatectomy

MeSH Terms

Abscess
Biliary Tract
Carcinoma, Hepatocellular
Catheter Ablation
Drainage
Female
Fistula
Follow-Up Studies
Hepatectomy
Humans
Liver
Liver Abscess
Lung Abscess
Middle Aged
Pleural Effusion

Figure

  • Fig. 1 Endoscopic retrograde cholangiopancreatography shows structure of the common hepatic duct (arrow) and mild dilatation of the left and right hepatic ducts.

  • Fig. 2 Abdominal CT reveals another newly appeared abscess pocket in the right basal lung and a fistula (arrow) showing communications between the radiofrequency-ablated cavity in the liver and the bronchial tree, including the pneumonic consolidation involving the middle right and lower lobes of the lung.

  • Fig. 3 (A) Operative field after right posterior sectionectomy and primary repair of the diaphragmatic defect shows exposure of left biliary stent (clamping with curved forceps) and opening of the left hepatic duct (arrow). (B) Schematic figure.

  • Fig. 4 (A) Preoperative chest X-ray shows pleural effusion and pneumonic consolidation in the lower right lobe of the lung. (B) A follow-up chest X-ray taken 2 months after operation demonstrates improvements of pneumonia and pleural effusion in the right basal lung.


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