A case of hepatolithiasis with hepatocellular carcinoma and biliary reconstruction that developt a liver abscess and sepsis after radiofrequency ablation

Abstract

A 69-year-old man developed fever and jaundice. Endoscopic retrograde cholangiopancreatography revealed a radiolucent mass in the hilar bile duct and the intrahepatic bile duct in the left hepatic lobe. Abdominal computed tomography showed HCC in segment 5 (S5). He had radiofrequency ablation (RFA) for the HCC, and an extended left hepatic lobectomy combined with extrahepatic bile duct resection and biliary reconstruction for suspected hilar bile duct cancer. Based on the resected specimens, hepatolithiasis was diagnosed ; there was no evidence of hilar cancer. On the 12th postoperative day, the patient developed a 39-40°C fever and septic shock. Abdominal ultrasonography confirmed a solitary liver abscess at the ablation site. Percutaneous transhepatic abscess drainage was performed promptly. RFA has been widely adopted as a local treatment for HCC because it has a good therapeutic effect and low invasiveness. However, a liver abscess can develop in the ablated site due to ascending cholangitis in patients with biliary reconstruction. Such patients should be closely monitored for liver abscess formation and the possible development of septic shock.