The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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A Delayed Hepatico-colonic Fistula after Radiofrequency Ablation in Hepatocellular Carcinoma

고주파절제술 후 발생한 지연성 간농양-횡행결장 누공 1예

  • Lee, Dong-Jun (Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine) ;
  • Song, Myung Eun (Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine) ;
  • Park, Jun Yong (Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine) ;
  • Ahn, Sang Hoon (Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine) ;
  • Han, Kwang Hyub (Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine) ;
  • Kim, Do Young (Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine)
  • 이동준 (연세대학교 의과대학 내과학교실, 소화기병연구소) ;
  • 송명은 (연세대학교 의과대학 내과학교실, 소화기병연구소) ;
  • 박준용 (연세대학교 의과대학 내과학교실, 소화기병연구소) ;
  • 안상훈 (연세대학교 의과대학 내과학교실, 소화기병연구소) ;
  • 한광협 (연세대학교 의과대학 내과학교실, 소화기병연구소) ;
  • 김도영 (연세대학교 의과대학 내과학교실, 소화기병연구소)
  • Received : 2014.01.27
  • Accepted : 2014.02.28
  • Published : 2014.06.01
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Abstract

Percutaneous radiofrequency thermal ablation (RFA) performed under ultrasound guidance is a safe, effective therapeutic modality for managing liver malignancies. Although surgical resection remains the treatment of choice for hepatocellular carcinoma (HCC), RFA has emerged as a reliable alternative. Potential complications of RFA include liver abscess, ascites, pleural effusion, skin burns, hypoxemia, pneumothorax, subcapsular hematoma, hemoperitoneum, liver failure, tumor seeding, and biliary lesions. Here, we report a rare complication after RFA for HCC: a delayed liver abscess and transverse colonic fistula. The patient was treated successfully with percutaneous abscess drainage, antibiotics, liver segmentectomy, and segmental resection of the fistula and involved colon. Due to its rarity, we report this case and review the literature.

초음파 가이드를 이용한 고주파 열치료는 간세포암 치료에 있어 효과적이고 안전한 치료방법이다. 비록 간세포암의 최선의 치료법은 수술적 절제이나 고주파 열치료는 이러한 수술을 대체할 수 있는 대안으로 떠오르고 있다. 고주파 열치료의 잠재적 합병증으로 간농양, 복수, 흉수, 피부 화상, 저산소증, 기흉, 간피막하 혈종, 혈복강, 간부전, 종양 파종, 담도 병변 등이 있다. 본 증례에서는 매우 드문 합병증으로 간세포암에 대해 고주파 열치료 후 지연형으로 발생한 간농양-횡행결장 누공을 보고 하는 바이다. 환자는 경피적 농양배액술 및 항생제 치료 후 간의 부분절제와 결장을 포함한 누공의 절제를 통하여 성공적으로 치료되었다. 본 증례의 희소성으로 인하여 문헌고찰과 함께 보고하는 바이다.

Keywords

References

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