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Case Reports
. 2014 Jan;29(1):101-5.
doi: 10.3904/kjim.2014.29.1.101. Epub 2014 Jan 2.

Hepatoduodenal fistula formation following transcatheter arterial chemoembolization and radiotherapy for hepatocellular carcinoma: treatment with endoscopic Histoacryl injection

Jaryong Jeon  1 , Joonseong Ahn  1 , Hongseok Yoo  1 , Taek Kyu Park  1 , Dongmo Je  1 , Hyemin Jeong  1 , Kwang Hyuck Lee  1
Affiliations
Case Reports

Hepatoduodenal fistula formation following transcatheter arterial chemoembolization and radiotherapy for hepatocellular carcinoma: treatment with endoscopic Histoacryl injection

Jaryong Jeon et al. Korean J Intern Med. 2014 Jan.

Abstract

A 71-year-old male patient was readmitted to our hospital 1 month after discharge because of relapse of abdominal pain. He had been diagnosed with hepatocellular carcinoma (HCC) 1 year prior and had undergone repeated transcatheter arterial chemoembolization and radiotherapy. During the last hospitalization, he was diagnosed with a liver abscess complicated by previous treatments for HCC and was treated with intravenous antibiotics and abscess aspiration. Follow-up abdominal computed tomography revealed a liver abscess with a duodenal fistula, which was successfully treated with endoscopic Histoacryl injection into the fistula. Liver abscesses with duodenal fistulas rarely occur, but they are intractable and possibly fatal in patients with HCC. In the literature, they have frequently been managed only with abscess treatment without fistula management. We herein report the first case of a patient with a liver abscess complicated by a fistula between the duodenum and the abscess, which was treated with endoscopic Histoacryl injection.

Keywords: Abscess; Carcinoma, hepatocellular; Endoscopy; Fistula.

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Conflict of interest statement

No potential conflict of interest relevant to this article is reported.

Figures

Figure 1
Figure 1
Serial contrast-enhanced computed tomography findings. (A) A gas-containing cavity is seen, suggestive of an abscess within a necrotic mass in the left lateral segment of the liver. (B) Communication between the liver abscess cavity and the duodenal bulb is present (arrows). (C) The fistulous tract is obliterated and the extent of the abscess has decreased.
Figure 2
Figure 2
Endoscopic findings. (A) The fistula orifice is seen at the proximal portion of the duodenal bulb. (B) The fistula opening remains visible beside the clips. (C) The fistula orifice is filled with Histoacryl after Histoacryl injection.
Figure 3
Figure 3
The clinical course of the patient from the time of hepatocellular carcinoma (HCC) diagnosis. RT, radiation therapy; TACE, transcatheter arterial chemoembolization.
See this image and copyright information in PMC

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