Abstract
Objective
The purpose of this study was to report on the clinical course and imaging findings of hemobilia after radiofrequency (RF) ablation in four patients with hepatocellular carcinoma (HCC).
Materials and methods
From July 2000 to December 2005, we experienced four cases of hemobilia after 1574 sessions of ultrasonography (US)-guided RF ablation in 1037 patients with HCCs. All ablation procedures were percutaneously performed with an internally cooled RF electrode system. The diagnosis of hemobilia was made if the patient complained of melena after RF ablation and biliary dilatation with high attenuating bile was noted at CT obtained immediately after RF ablation. We evaluated the clinical course and imaging findings of hemobilia caused by RF ablation.
Results
All patient well tolerated RF ablation procedures without any incident during the procedure. Three of four patients complained of melena with an interval from 1 day to 4 days after RF ablation. One patient was asymptomatic. The melena symptom in all symptomatic patients spontaneously improved in 2 days. None of the patients showed substantial change in vital sign and the level of hemoglobin during the admission period. In all four patients, biliary (including GB) dilatation with high attenuating bile was noted at immediate follow-up CT. The CT findings in all four patients disappeared at 1 month follow-up CT.
Conclusion
Hemobilia is a rare potential complication of RF ablation with a favorable prognosis. Clinicians who use this technique should be aware of the characteristic CT findings and clinical course of hemobilia after RF ablation for liver tumors.
Similar content being viewed by others
References
Dupuy DE, Goldberg SN (2001) Image-guided radiofrequency tumor ablation: challenges and opportunities—part II. J Vasc Interv Radiol 12:1135–1148
Goldberg SN, Grassi CJ, Cardella JF, et al. (2005) Image-guided tumor ablation: standardization of terminology and reporting criteria. Radiology 235(3):728–739. Epub 2005 Apr 21. (review)
Dodd GD 3rd, Soulen MC, Kane RA, et al. (2000) Minimally invasive treatment of malignant hepatic tumors: at the threshold of a major breakthrough. Radiographics 20(1):9–27 (review)
Tateishi R, Shiina S, Teratani T (2005) Percutaneous radiofrequency ablation of hepatocellular carcinoma: an analysis in 1000 cases. Cancer 103:1201–1209
Lencioni R, Cioni D, Crocetti L, et al. (2005) Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation. Radiology 234(3):961–967
Mulier S, Mulier P, Ni Y, et al. (2002) Complications of radiofrequency coagulation of liver tumours. Br J Surg 89:1206–1222
Livraghi T, Solbiati L, Meloni MF, et al. (2003) Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology 226(2):441–451
Rhim H, Yoon KH, Lee JM, et al. (2003) Major complications after radio-frequency thermal ablation of hepatic tumors: spectrum of imaging findings. Radiographics 23(1):123–134; discussion 134–136
Curley SA, Marra P, Beaty K, et al. (2004) Early and late complications after radiofrequency ablation of malignant liver tumors in 608 patients. Ann Surg 239(4):450–458
Akahane M, Koga H, Kato N, et al. (2005) Complications of percutaneous radiofrequency ablation for hepato-cellular carcinoma: imaging spectrum and management. Radiographics 1(25 Suppl):S57–S68
Kim SH, Lim HK, Choi D, et al. (2004) Changes in bile ducts after radiofrequency ablation of hepatocellular carcinoma: frequency and clinical significance. AJR Am J Roentgenol 183(6):1611–1167
Enne M, Pacheco-Moreira LF, Cerqueira A, et al. (2004) Fatal hemobilia after radiofrequency thermal ablation for hepatocellular carcinoma. Surgery 135(4):460–461
Lim HK, Choi D, Lee WJ, et al. (2001) Hepatocellular carcinoma treated with percutaneous radio-frequency ablation: evaluation with follow-up multiphase helical CT. Radiology 221(2):447–454
Obi S, Shiratori Y, Shiina S, et al. (2000) Early detection of hemobilia associated with percutaneous ethanol injection for hepatocellular carcinoma. Eur J Gastroenterol Hepatol 12(3):285–290
Joo YE, Kim HS, Choi SK, et al. (2003) Hemobilia caused by liver abscess due to intrahepatic duct stones. J Gastroenterol 38(5):507–511
Yamamoto T, Kubo S, Hirohashi K (2003) Secondary hemocholecyst after radiofrequency ablation therapy for hepatocellular carcinoma. J Gastroenterol 38(4):399–403 (review)
Rhim H (2005) Complications of radiofrequency ablation in hepatocellular carcinoma. Abdom Imaging 30(4):409–418 (review)
Xu ZB, Zhou XY, Peng ZY, et al. (2005) Evaluation of selective hepatic angiography and embolization in patients with massive hemobilia. Hepatobiliary Pancreat Dis Int 4(2):254–258
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rhim, H., Lim, H.K., Kim, YS. et al. Hemobilia after radiofrequency ablation of hepatocellular carcinoma. Abdom Imaging 32, 719–724 (2007). https://doi.org/10.1007/s00261-006-9158-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-006-9158-0