Thermal protection with 5% dextrose solution blanket during radiofrequency ablation

Abstract

A serious complication for any thermal radiofrequency ablation is thermal injury to adjacent structures, particularly the bowel, which can result in additional major surgery or death. Several methods using air, gas, fluid, or thermometry to protect adjacent structures from thermal injury have been reported. In the cases presented in this report, 5% dextrose water (D5W) was instilled to prevent injury to the bowel and diaphragm during radiofrequency ablation. Creating an Insulating envelope or moving organs with D5W might reduce risk for complications such as bowel perforation.

Fig. 1

A 32-year-old female with metastatic adrenocortical carcinoma. (A) Enhanced coronal T1-weighted sequence demonstrates the right lobe lesion (black arrow) abutting the colon at the hepatic flexure (white arrow). (B) T2-weighted axial MRI shows high signal liver metastasis above level of colonic abutment. (C) Axial CT image after perihepatic D5W solution through a 5F sheath (black arrow) demonstrates insulating fluid envelope posterior to liver (white arrow). (D) Coronal MRI image performed 1 week post-RFA. RFA ablation zone touches colon along inferior margin (white arrow).

Fig. 2

A 37-year-old man with cholangiocarcinoma metastatic to the liver. (A) Ultrasound image shows hypoechoic fluid rim between the liver and diaphragm. (B) Postablation enhanced CT image demonstrating D5W within the periheptic space.

Fig. 3

A 31-year-old man with von Hippel Landau. Axial CT image minutes after RFA shows fluid (arrow) between kidney tumor and colon. RFA needle within renal tumor after RFA (white arrow).