Endobronchial Watanabe Spigot Placement for Hepatic Abscess and Bronchobiliary Fistula Following Radiofrequency Ablation for Hepatocellular Carcinoma

Intern Med. 2023 Apr 1;62(7):999-1004. doi: 10.2169/internalmedicine.0392-22. Epub 2022 Aug 10.

Abstract

A bronchobiliary fistula (BBF) is an uncommon but severe complication after radiofrequency ablation (RFA). However, the definitive salvage methods are controversial. We herein report a patient with hepatocellular carcinoma with hepatic abscess and BBF following RFA. We also review previous reports of BBF after RFA. The patient was a man in his 70s who underwent RFA for recurrent hepatocellular carcinoma in the subphrenic area. Despite percutaneous transhepatic abscess drainage, bilioptysis persisted. Finally, the BBF was occluded with an endobronchial Watanabe spigot under fiber-optic bronchoscopy. Placing an endobronchial Watanabe spigot should be considered as a salvage therapy for refractory BBF following RFA.

Keywords: ablation; abscess; bronchobiliary fistula; hepatocellular carcinoma; thermal injury.

MeSH terms

  • Biliary Fistula* / etiology
  • Biliary Fistula* / surgery
  • Bronchial Fistula* / etiology
  • Bronchial Fistula* / surgery
  • Carcinoma, Hepatocellular* / complications
  • Carcinoma, Hepatocellular* / surgery
  • Catheter Ablation* / adverse effects
  • Humans
  • Liver Abscess* / etiology
  • Liver Abscess* / surgery
  • Liver Neoplasms* / complications
  • Male
  • Radiofrequency Ablation* / adverse effects