Radiofrequency ablation (RFA) is a minimally invasive, image-guided procedure for the treatment of hepatic tumors. While RFA is associated with relatively low morbidity, sporadic bronchobiliary fistulae due to thermal damage may occur after RFA, although the incidence is rare. We describe a patient with a bronchobiliary fistula complicated by a liver abscess that occurred after RFA. This fistula was obliterated after placement of an external drainage catheter into the liver abscess for eight weeks.
Adult ; Biliary Fistula/*etiology/*surgery ; Bronchial Fistula/*etiology/*surgery ; Carcinoma, Hepatocellular/*surgery ; Catheter Ablation/*adverse effects ; Drainage/*methods ; Female ; Humans ; Liver Abscess/etiology/surgery ; Liver Neoplasms/*surgery

Primary adenosquamous carcinoma of the liver is a very rare type of cholangiocarcinoma and is defined as a cancer containing both squamous and adenomatous components in the same lesion. Recently, we experienced a primary adenosquamous carcinoma of the liver presented as liver abscess. A 63-year-old man was presented with a 4-day history of fever and chill. The radiologic study showed a 4 cm-sized, central hypoattenuated mass with peripheral rim enhancement in the left lobe of the liver. Ultrasonography-guided aspiration and biopsy suggested an adenocarcinoma with abscess in the liver. At laparotomy, the tumor occupied the left lobe of the liver and invaded the right diaphragm. An extended left lobectomy and a partial excision of the involved diaphragm were done. Grossly, the tumor was 6x5x5 cm in size and had an eccentric necrosis. Microscopically, the tumor was composed of adenocarcinoma and squamous cell carcinoma with a transitional area.
Carcinoma, Adenosquamous/*complications/pathology/surgery ; Case Report ; Human ; Liver Abscess/*etiology ; Liver Neoplasms/*complications/pathology/surgery ; Male ; Middle Age

Idiopathic cecal ulcer is a rare disease entity of unknown cause diagnosed by ruling out other known causes of cecal ulceration. The most common complication of an idiopathic cecal ulcer is bleeding; perforation, peritonitis, abscess, and stricture formation have been noted. The authors treated a 53-year-old woman who presented with fever and intermittent right upper quadrant abdominal pain. Multiple pyogenic liver abscess and a solitary cecal ulcer were diagnosed by radiologic, endoscopic, and pathologic examination, followed by laparoscopic cecectomy. After extensive study, we concluded that this patient's liver abscesses were a complication of the idiopathic cecal ulcer. Herein, we report a case of multiple pyogenic liver abscess caused by microperforation of idiopathic cecal ulcer.
Cecal Diseases/complications/*diagnosis/surgery ; Colonoscopy ; Female ; Humans ; Laparoscopy ; Liver/pathology ; Liver Abscess, Pyogenic/*diagnosis/etiology ; Middle Aged ; Tomography, X-Ray Computed ; Ulcer/complications/*diagnosis/surgery

BACKGROUND/AIMS: Radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) have been applied for treating hepatocellular carcinoma (HCC), but procedure-related complications can be a serious problem. This study was conducted to evaluate the clinical features of HCC patients who developed liver abscess after RFA and TACE, as compared to those patients without malignancy. METHODS: In our center, from December 1999 to March 2004, 31 cases of liver abscess developed after local treatment of HCC (13/751 after RFA and 18/8417 after TAE), which correspond to 5.1% of the total cases (602) of liver abscess. We evaluated the patients' clinical features, the abscess characteristics, the bacteriology, treatment modality, hospital days and mortality, as compared to those characteristics of 263 abscess patients without malignancy. RESULTS: The time required to diagnose liver abscess was longer in the TACE group (24.8+/-16.5 days) compared to that of the other two groups (12.2+/-9.0 days in the RFA group, 9.6+/-7.5 days in the controls, P=0.001). Gas-forming liver abscess is most frequently found in the RFA groups (76.9%). There were more hospitalized days for the TACE groups than for the RFA group and the controls (34.7+/-19.8 vs. 15.2+/-9.2 vs. 18.6+/-10.9 days, respectively, P<0.001). Two patients (11%) in the TACE group died of sepsis and liver failure. CONCLUSIONS: For the patients with prolonged fever after RFA and especially after TACE for HCC, a diagnosis of liver abscess should be suspected earlier to reduce the morbidity and mortality due to liver abscess per se and also the sepsis-related decompensation of the liver.
Middle Aged ; Male ; Liver Neoplasms/surgery/*therapy ; Liver Abscess/diagnosis/*etiology/microbiology ; Humans ; Female ; Chemoembolization, Therapeutic/*adverse effects ; Catheter Ablation/*adverse effects ; Carcinoma, Hepatocellular/surgery/*therapy ; Aged ; Adult

Transarterial chemoembolization (TACE) is one of the most effective therapies for unresectable hepatocelluar carcinoma or metastatic hypervascular tumors. Abscess occurring in the other organs beside the liver after TACE is a complication that often occurs, sometimes potentially fatal. We report a case of spinal epidural abscess occurred after liver abscess complicated by TACE in a patient with metastatic neuroendocrine tumors to the liver. A 67-year-old female underwent TACE first for the metastatic lesions to liver, with a history of pancreatoduodenectomy for the primary pancreatic neuroendocrine tumor. Four days after TACE, sudden high fever occurred, and liver abscess was found on abdominal CT. Two days later, back pain and radiating pain to the right leg occurred, and lumbar spine MRI showed spinal epidural abscess. After intravenous antibiotics for 8 weeks and partial laminectomy, the patient recovered and was discharged without complications.
Aged ; Anti-Bacterial Agents/therapeutic use ; Carcinoma, Hepatocellular/secondary/*therapy ; Chemoembolization, Therapeutic/*adverse effects ; Epidural Abscess/*etiology/microbiology/surgery ; Escherichia coli/isolation & purification ; Escherichia coli Infections/drug therapy ; Female ; Humans ; Laminectomy ; Liver Abscess/*etiology ; Liver Neoplasms/secondary/*therapy ; Lumbar Vertebrae/microbiology/radiography ; Magnetic Resonance Imaging ; Neuroendocrine Tumors/pathology/surgery ; Pancreaticoduodenectomy ; Tomography, X-Ray Computed

OBJECTIVETo analyze the major complications of percutaneous cooled-tip microwave ablation for the treatment of primary liver cancer and the possible risk factors of severe complications in a series of 693 patients.

METHODSThe clinicopathological data of 693 patients with primary liver cancer who underwent ultrasound-guided percutaneous cooled-tip microwave (MW) ablation in our hospital over the past 5 years were retrospectively analyzed, and the risk factors of severe complications were explored.

RESULTSIn a total of 693 patients with 898 primary liver tumors were treated and 1111 MW ablation sessions were performed. The mean diameter of tumors was (2.5 ± 1.2) cm and the range was 0.4 - 10.0 cm. Three deaths occurred in the peri-ablation period, including one case died of multiorgan failure, one case died of pulmonary embolism and one case died of hepatorenal syndrome. Major complications occurred in 27 (3.9%) patients, including 12 pleural effusion requiring thoracentesis (1.7%), 10 tumor seeding (1.4%), 3 liver abscess and empyema (0.4%), 1 hemorrhage requiring arterial embolization (0.1%), and 1 bile duct injury (0.1%). The Chi-square test results showed that the diameter of tumors, number of MW ablation sessions and histological type of tumor were significantly associated with the major complications rate (P < 0.05). The multiple variables 1ogistic regression analysis showed that only type of tumors was associated with the major complication rate (P < 0.05).

CONCLUSIONSResults of this study confirm that cooled-tip MW ablation is a relatively low-risk and effective minimally invasive procedure for the treatment of primary liver cancer. Proper direction for the treatment of cholangiocarcinoma (ICC) patients as well as fewer ablated tumor numbers during one hospital stay may help minimize the major complication rate in patients with primary liver cancer treated by ultrasound-guided percutaneous cooled-tip microwave ablation.

Adult ; Aged ; Aged, 80 and over ; Bile Duct Neoplasms ; diagnostic imaging ; surgery ; Bile Ducts, Intrahepatic ; Carcinoma, Hepatocellular ; diagnostic imaging ; surgery ; Catheter Ablation ; adverse effects ; methods ; Cholangiocarcinoma ; diagnostic imaging ; surgery ; Female ; Follow-Up Studies ; Humans ; Liver Abscess ; drug therapy ; etiology ; Liver Neoplasms ; diagnostic imaging ; surgery ; Male ; Microwaves ; therapeutic use ; Middle Aged ; Neoplasm Seeding ; Pleural Effusion ; etiology ; surgery ; Retrospective Studies ; Ultrasonography, Interventional

Gastrointestinal stromal tumor (GIST) is an uncommon mesenchymal tumor of the gastrointestinal tract and is generally located in the stomach and small intestine. They usually present with abdominal pain, gastrointestinal bleeding, and palpable mass. Some patients present with rare symptoms that are more common in malignant GIST. Malignant GIST combined with a liver abscess has not been reported yet in the literatures. We report a case of 67-year-old woman who suffered from liver abscess combined by malignant GIST with central necrosis and fistula in the ileum. She complained of fever, chills, and abdominal pain. Abdominal CT scan showed huge liver abscess and ileal mass with air pocket. Small bowel series showed contrast material filling into the ileal GIST mass. An operation was performed and the final diagnosis was malignant GIST of the ileum with invasion into the sigmoid colon and urinary bladder.
Aged ; Diagnosis, Differential ; Female ; Gastrointestinal Stromal Tumors/*diagnosis/pathology/surgery ; Humans ; Ileal Neoplasms/*diagnosis/pathology/surgery ; Liver Abscess/*etiology ; Neoplasm Invasiveness ; Proto-Oncogene Proteins c-kit/analysis ; Reagent Kits, Diagnostic

Hepatocellular carcinoma (HCC) is one of the most common malignant neoplasms occuring worldwide. Although surgical resection still remains the treatment of choice for HCC, radiofrequency ablation (RFA) has emerged as reliable alternatives to resection. It is less invasive and can be repeated after short intervals for sequential ablation in case of multiple lesions. The most common complication of RFA is liver abscess, and bile duct injury such as bile duct stricture has been reported. This is a case report of a rare complication of abscesso-colonic fistula after RFA for HCC. The case was treated by percutaneous abscess drainage and antibiotics and occlusion of abscesso-colonic fistula with n-butyl-2-cyanoacrylate embolization.
Aged ; Anti-Bacterial Agents/therapeutic use ; Carcinoma, Hepatocellular/diagnosis/*surgery ; Catheter Ablation/*adverse effects ; Colonic Diseases/etiology/*therapy ; Drainage ; Embolization, Therapeutic ; Enbucrilate/*therapeutic use ; Humans ; Intestinal Fistula/etiology/*therapy ; Liver Abscess/etiology/ultrasonography ; Liver Neoplasms/diagnosis/*surgery ; Male ; Pseudomonas aeruginosa/isolation & purification ; Tomography, X-Ray Computed

Intrahepatic abscess is an unusual complication of peptic ulcer disease. We present a case of gastric cancer in which the ulcer penetrated into the left lobe of liver with subsequent abscess and fistula formation. Esophagogastroduodenoscopy confirmed ulcers and a fistula opening in the antrum. Abdominal computed tomogram showed a subcapsular liver abscess adjacent to the gastric antrum. Subtotal gastrectomy with curettage of the fistulous tract was performed. The final diagnosis was the signet ring cell gastric carcinoma complicating subcapsular liver abscess. To our knowledge, this is the first reported case in Korea.
Endoscopy, Gastrointestinal ; Female ; Humans ; Klebsiella pneumoniae/isolation & purification ; Liver Abscess/diagnosis/*etiology/microbiology ; Middle Aged ; Peptic Ulcer Perforation/*complications/diagnosis ; Stomach Neoplasms/complications/*diagnosis/surgery ; Tomography, X-Ray Computed