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Thermal Injury to the Subhepatic Appendix Following Percutaneous Ultrasound-Guided Radiofrequency Ablation for Hepatocellular Carcinoma: A Case Report

We present the first documented case of a fistula between the treated zone and the appendix after RFA in a patient with HCC. Contrast-enhanced CT and MRI revealed a subcapsular hepatic nodule with image findings of HCC located adjacent to the ascending colon and cecum. An ultrasound-guided core need...

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Autores principales: Yoon, Eun Ju, Kim, Jin Woong, Hong, Jun Hyung, Song, Sang Gook, Kim, Hyun Chul, Hur, Young Hoe, Kim, Hyung Joong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10647334/
https://www.ncbi.nlm.nih.gov/pubmed/37958216
http://dx.doi.org/10.3390/diagnostics13213322
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author Yoon, Eun Ju
Kim, Jin Woong
Hong, Jun Hyung
Song, Sang Gook
Kim, Hyun Chul
Hur, Young Hoe
Kim, Hyung Joong
author_facet Yoon, Eun Ju
Kim, Jin Woong
Hong, Jun Hyung
Song, Sang Gook
Kim, Hyun Chul
Hur, Young Hoe
Kim, Hyung Joong
author_sort Yoon, Eun Ju
collection PubMed
description We present the first documented case of a fistula between the treated zone and the appendix after RFA in a patient with HCC. Contrast-enhanced CT and MRI revealed a subcapsular hepatic nodule with image findings of HCC located adjacent to the ascending colon and cecum. An ultrasound-guided core needle biopsy was subsequently performed to distinguish between hepatic metastasis and HCC. Post-RFA imaging identified a low-attenuating ablated area adjacent to an air-filled appendix. The patient later experienced complications, including increased liver enzymes and an abscess at the ablation site. Imaging revealed a fistulous tract between the RFA zone and the appendix. Over the following months, the patient underwent conservative treatment involving intravenous antibiotics and repeated percutaneous drainage, exhibiting eventual symptom relief and an absence of the fistulous tract upon subsequent imaging. This case highlights the rare complications that can arise during RFA due to peculiar anatomical variations, such as a subhepatic appendix, resulting from midgut malrotation and previous surgery. It is imperative for operators to be cognizant of potential anatomical variations when considering RFA treatment, ensuring comprehensive pre-procedural imaging and post-procedure monitoring. This case also emphasizes the potential viability of nonoperative management in complex scenarios in which surgical interventions pose significant risks.
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spelling pubmed-106473342023-10-26 Thermal Injury to the Subhepatic Appendix Following Percutaneous Ultrasound-Guided Radiofrequency Ablation for Hepatocellular Carcinoma: A Case Report Yoon, Eun Ju Kim, Jin Woong Hong, Jun Hyung Song, Sang Gook Kim, Hyun Chul Hur, Young Hoe Kim, Hyung Joong Diagnostics (Basel) Interesting Images We present the first documented case of a fistula between the treated zone and the appendix after RFA in a patient with HCC. Contrast-enhanced CT and MRI revealed a subcapsular hepatic nodule with image findings of HCC located adjacent to the ascending colon and cecum. An ultrasound-guided core needle biopsy was subsequently performed to distinguish between hepatic metastasis and HCC. Post-RFA imaging identified a low-attenuating ablated area adjacent to an air-filled appendix. The patient later experienced complications, including increased liver enzymes and an abscess at the ablation site. Imaging revealed a fistulous tract between the RFA zone and the appendix. Over the following months, the patient underwent conservative treatment involving intravenous antibiotics and repeated percutaneous drainage, exhibiting eventual symptom relief and an absence of the fistulous tract upon subsequent imaging. This case highlights the rare complications that can arise during RFA due to peculiar anatomical variations, such as a subhepatic appendix, resulting from midgut malrotation and previous surgery. It is imperative for operators to be cognizant of potential anatomical variations when considering RFA treatment, ensuring comprehensive pre-procedural imaging and post-procedure monitoring. This case also emphasizes the potential viability of nonoperative management in complex scenarios in which surgical interventions pose significant risks. MDPI 2023-10-26 /pmc/articles/PMC10647334/ /pubmed/37958216 http://dx.doi.org/10.3390/diagnostics13213322 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Interesting Images
Yoon, Eun Ju
Kim, Jin Woong
Hong, Jun Hyung
Song, Sang Gook
Kim, Hyun Chul
Hur, Young Hoe
Kim, Hyung Joong
Thermal Injury to the Subhepatic Appendix Following Percutaneous Ultrasound-Guided Radiofrequency Ablation for Hepatocellular Carcinoma: A Case Report
title Thermal Injury to the Subhepatic Appendix Following Percutaneous Ultrasound-Guided Radiofrequency Ablation for Hepatocellular Carcinoma: A Case Report
title_full Thermal Injury to the Subhepatic Appendix Following Percutaneous Ultrasound-Guided Radiofrequency Ablation for Hepatocellular Carcinoma: A Case Report
title_fullStr Thermal Injury to the Subhepatic Appendix Following Percutaneous Ultrasound-Guided Radiofrequency Ablation for Hepatocellular Carcinoma: A Case Report
title_full_unstemmed Thermal Injury to the Subhepatic Appendix Following Percutaneous Ultrasound-Guided Radiofrequency Ablation for Hepatocellular Carcinoma: A Case Report
title_short Thermal Injury to the Subhepatic Appendix Following Percutaneous Ultrasound-Guided Radiofrequency Ablation for Hepatocellular Carcinoma: A Case Report
title_sort thermal injury to the subhepatic appendix following percutaneous ultrasound-guided radiofrequency ablation for hepatocellular carcinoma: a case report
topic Interesting Images
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10647334/
https://www.ncbi.nlm.nih.gov/pubmed/37958216
http://dx.doi.org/10.3390/diagnostics13213322
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