J Liver Cancer.  2019 Mar;19(1):69-73. 10.17998/jlc.19.1.69.

Gallbladder Fistula Treated with N-Butyl-2-Cyanoacrylate after Radiofrequency Ablation in a Hepatocellular Carcinoma Patient: a Case Report

• So IT
• Jang BK
• Hwang JS
• Kim YH

• KMID: 2448280
• DOI: http://doi.org/10.17998/jlc.19.1.69

Abstract

Radiofrequency ablation (RFA) is a minimally invasive local therapy for hepatocellular carcinoma (HCC). Even though RFA is considered to be a safe treatment modality, a variety of complications have been reported. Recently, we encountered a case of refractory fistula between a liver abscess and the gallbladder after RFA. A 64-year-old woman diagnosed with HCC associated with chronic hepatitis B was treated by RFA. After RFA, she experienced abdominal pain, and abdominal computed tomography (CT) revealed a liver abscess complicated by a previous treatment of HCC, she was treated with intravenous antibiotics and percutaneous abscess drainage. Follow-up abdominal CT revealed a fistula between the liver abscess and gallbladder, which was successfully treated with percutaneous transcatheter n-butyl-2-cyanoacrylate (NBCA) embolization. We herein report the rare case of a refractory fistula between a liver abscess and the gallbladder after RFA in a patient treated with NBCA embolization.

Keyword

Hepatocellular carcinoma; Radiofrequency ablation; Fistula; N-butyl-2-cyanoacrylate

MeSH Terms

Abdominal Pain
Abscess
Anti-Bacterial Agents
Carcinoma, Hepatocellular*
Catheter Ablation*
Drainage
Enbucrilate*
Female
Fistula*
Follow-Up Studies
Gallbladder*
Hepatitis B, Chronic
Humans
Liver Abscess
Middle Aged
Tomography, X-Ray Computed
Anti-Bacterial Agents
Enbucrilate

Figure

• 

  Figure 1. Dynamic CT during arterial phase showing an ill-defined, irregularly shaped liver abscess in the right anterior, superior segment of the liver and perihepatic fluid collection. CT, computed tomography.

• 

  Figure 2. Dynamic CT showing an abscess and gallbladder fistula (white arrow). CT, computed tomography.

• 

  Figure 3. Tubography via a pigtail catheter showing the passage of the contrast dye through the gallbladder, cystic duct, common bile duct, and duodenum due to fistula formation between the abscess and gallbladder.

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  Figure 4. (A) Tubography showing fistula embolization with an NBCA-lipiodol mixture, and NBCA is observed along the previous remnant abscess, fistula tract, and gallbladder. (B) After the fistula tract embolization procedure, the percutaneous drainage catheter was removed. NBCA, n-butyl-2-cyanoacrylate.

• 

  Figure 5. CT showing the remnant abscess, fistula tract, and gallbladder cavity sealed with NBCA. CT, computed tomography; NBCA, n-butyl-2-cyanoacrylate.

• 

  Figure 6. Tubography showing the fistula tract occlusion through non-visualization of the cystic duct, common bile duct, and duodenum after dyeinjection.

Reference

1. Bruix J, Llovet JM. Prognostic prediction and treatment strategy in hepatocellular carcinoma. Hepatology. 2002; 35:519–524.

2. Rossi S, Buscarini E, Garbagnati F, Di Stasi M, Quaretti P, Rago M, et al. Percutaneous treatment of small hepatic tumors by an expandable RF needle electrode. AJR Am J Roentgenol. 1998; 170:1015–1022.

3. Bai XM, Yang W, Zhang ZY, Jiang AN, Wu W, Lee JC, et al. Longterm outcomes and prognostic analysis of percutaneous radiofrequency ablation in liver metastasis from breast cancer. Int J Hyperthermia. 2019; 35:183–193.

4. Livraghi T, Solbiati L, Meloni MF, Gazelle GS, Halpern EF, Goldberg SN. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology. 2003; 226:441–451.

5. Rhim H, Yoon KH, Lee JM, Cho Y, Cho JS, Kim SH, et al. Major complications after radio-frequency thermal ablation of hepatic tumors: spectrum of imaging findings. Radiographics. 2003; 23:123–134. ; discussion 134-136.

6. Bertot LC, Sato M, Tateishi R, Yoshida H, Koike K. Mortality and complication rates of percutaneous ablative techniques for the treatment of liver tumors: a systematic review. Eur Radiol. 2011; 21:2584–2596.

7. Bae JH, Kim GC, Ryeom HK, Jang YJ. Percutaneous embolization of persistent biliary and enteric fistulas with Histoacryl. J Vasc Interv Radiol. 2011; 22:879–883.

8. York JA. Treating bronchopleural fistulae percutaneously with Nbutyl cyanoacrylate glue. J Vasc Interv Radiol. 2013; 24:1581–1583.

9. Nunes TF, de Santi GF. Percutaneous embolization of a colonic fistula using n-butyl-2 cyanoacrylate (Histoacryl[R]). Tech Coloproctol. 2017; 21:763–765.

10. Lopes MF, Catré D, Reis A, Leitão LM. Endoscopic treatment of recurrent tracheoesophageal fistula with histoacryl glue. Gastrointest Endosc. 2010; 72:1324–1325. ; author reply 1325.