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Case Reports
. 2023 Aug 24;18(11):3787-3790.
doi: 10.1016/j.radcr.2023.08.045. eCollection 2023 Nov.

Percutaneous embolization of refractory biliocutaneous fistula following radiofrequency ablation: A case report

Mei-Chen Chen  1 , Hsuen-En Hwang  1   2 , Nai-Chi Chiu  1   2 , Rheun-Chuan Lee  1   2 , I-Cheng Lee  2   3 , Chien-An Liu  1   2
Affiliations
Case Reports

Percutaneous embolization of refractory biliocutaneous fistula following radiofrequency ablation: A case report

Mei-Chen Chen et al. Radiol Case Rep. .

Abstract

This case report presents a 73-year-old male with recurrent hepatocellular carcinoma who underwent serial surgical and interventional locoregional treatments, which resulted in asymptomatic intrahepatic bile duct dilatation. To address a recurrent tumor close to the pre-existing dilated bile ducts, radiofrequency ablation was performed, leading to a biliocutaneous fistula along the electrode tract. Attempts to close the refractory fistula by percutaneous transhepatic cholangial diversion and balloon dilatation of the stenotic central bile duct were unsuccessful. Ultimately, the fistula was successfully sealed with aggressive management, combining balloon-assisted retrograde fistulography and antegrade fistula embolization. This report aims to raise awareness of complex biliary complications after radiofrequency ablation in patients with preexisting bile duct dilatation, and emphasize the importance of aggressive intervention in cases of refractory biliocutaneous fistula based on our experience.

Keywords: Biliocutaneous fistula; Histoacryl; NBCA; Percutaneous embolization; Radiofrequency ablation (RFA).

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Figures

Fig 1
Fig. 1
CT demonstration of the recurrent HCC and post RFA change. (A) Recurrent HCC at S3 of liver(arrow) with nearby preexisting intrahepatic bile ducts dilatation(arrowhead). (B) Post CT-guided RFA, axial CT showed the position of electrode and the ablation zone. (C) Multiplanar reformatted CT revealed fistula tract with wall enhancement (dotted line) in oblique axial image. Note that the fistula arose from previous ablation zone to cutaneous entrance of electrode. HCC, hepatocellular carcinoma; RFA, radiofrequency ablation.
Fig 2
Fig. 2
Comprehensive visualization of biliocutaneous fistula using combined retrograde fistulography and antegrade cholangiography. (A) 6-Fr. Foley (as shown in yellow dotted line) was inserted into the wound and the balloon was inflated to block the fistula outlet. Then, contrast medium was injected via inflated Foley for fistulography. Under this manipulation, the abscess cavity and fistula tract were further opacified. (B) A KMP angiocatheter, also known as Kumpe Access Catheter (Cook Medical) was introduced along the PTCD tract and negotiated into proximal IHD branch, which revealed suspicious connection to abscess cavity. (C) A micro-catheter was inserted further into the aforementioned branch and the abscess cavity was better opacified after injecting contrast medium into micro-catheter. IHD, intrahepatic bile ducts; PTCD, percutaneous transhepatic cholangial drainage.
Fig 3
Fig. 3
Successful embolization of a refractory biliocutaneous fistula. (A) Antegrade transhepatic embolization was performed with NBCA glue for abscess cavity filling and micro-coils for inner fistula tract and short segment of IHD. (B) Follow-up CT demonstrated dense deposition of NBCA in abscess cavity and fistula tract. IHD, intrahepatic bile ducts; NBCA, histoacryl.
See this image and copyright information in PMC

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