Ann Surg Treat Res.  2014 Jul;87(1):41-43. 10.4174/astr.2014.87.1.41.

Delayed hepatic rupture after radiofrequency ablation for colorectal hepatic metastasis: management with transcatheter arterial embolization

• Chang IS
• Kim YJ
• Park SW
• Park HS
• Jeon HJ
• Chang SH
• Hwang DY

• KMID: 1804098
• DOI: http://doi.org/10.4174/astr.2014.87.1.41

Abstract

Intraperitoneal bleeding after radiofrequency ablation (RFA) is the most common major vascular complication due to direct needle injury to a vessel or liver capsule. However, intraperitoneal bleeding as a result of a delayed hepatic rupture after RFA for liver tumors is an extremely rare complication. The present report describes a case of intraperitoneal hemorrhage caused by delayed hepatic rupture resulting from arterioportal fistula after RFA for hepatic metastasis from colorectal cancer and successful management using transcatheter embolization.

Keyword

Liver; Colorectal neoplasms; Pulsed radiofrequency treatment; Therapeutic embolization

MeSH Terms

Catheter Ablation*
Colorectal Neoplasms
Embolization, Therapeutic
Fistula
Hemorrhage
Liver
Needles
Neoplasm Metastasis*
Pulsed Radiofrequency Treatment
Rupture*

Figure

• 

  Fig. 1 Serial changes of intrahepatic laceration and hematoma after radiofrequency ablation (RFA). (A) Abdominal computed tomography (CT) axial image before surgery shows 2.6-cm-sized peripherally rim enhanced hypodense mass in segment VII of liver (arrow). (B) Abdominal CT axial image one day after intraoperative RFA shows 2.3-cm-sized intrahepatic laceration and hematoma (arrow) in Couinaud segment V. (C) Abdominal CT coronal image seven days after intraoperative RFA shows pseudoaneurysm (arrow) abutting 1st order branch of portal vein in segment V. (D) Abdominal CT axial image eight days after intraoperative RFA shows hepatic rupture and intraperitoneal hemorrhage (arrow).

• 

  Fig. 2 Arterioportal fistula due to radiofrequency ablation, closed with coils and gelfoam. (A) Celiac arteriogram demonstrates early opacification of portal vein in segment V (arrowheads) and contrast extravasation (arrow). (B) Celiac arteriogram after embolization with coils (arrow) demonstrates no further arterioportal fistula and contrast extravasation.

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