Septic Shock and Death after Microwave Ablation of Hepatocellular Carcinoma in a Liver Transplant Patient with a Bilioenteric Anastomosis

Abstract

Percutaneous thermal ablation of hepatic tumors continues to play an integral role in the treatment of early-stage primary or secondary hepatic malignancies. Interventional radiologists must be familiar with potential complications of this procedure, associated risk factors, and methods for prevention. The authors report a devastating case of septic shock and death following percutaneous microwave ablation of a solitary hepatocellular carcinoma in a liver transplant patient with a bilioenteric anastomosis (BEA). We review the literature regarding prophylactic antibiotic regimens and bowel preparation prior to performing thermal ablation in patients with BEAs.

Keywords

septic shock - bilioenteric anastomosis - microwave ablation - antibiotics - hepatocellular carcinoma

• References

• 1 McCarley JR, Soulen MC. Percutaneous ablation of hepatic tumors. Semin Intervent Radiol 2010; 27 (03) 255-260
• 2 Ong SL, Gravante G, Metcalfe MS, Strickland AD, Dennison AR, Lloyd DM. Efficacy and safety of microwave ablation for primary and secondary liver malignancies: a systematic review. Eur J Gastroenterol Hepatol 2009; 21 (06) 599-605
• 3 Chernyak V, Fowler KJ, Kamaya A. , et al. Liver Imaging Reporting and Data System (LI-RADS) version 2018: imaging of hepatocellular carcinoma in at-risk patients. Radiology 2018; 289 (03) 816-830
• 4 Llovet JM, Brú C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 1999; 19 (03) 329-338
• 5 Lahat E, Eshkenazy R, Zendel A. , et al. Complications after percutaneous ablation of liver tumors: a systematic review. Hepatobiliary Surg Nutr 2014; 3 (05) 317-323
• 6 Livraghi T, Solbiati L, Meloni MF, Gazelle GS, Halpern EF, Goldberg SN. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology 2003; 226 (02) 441-451
• 7 Rhim H, Dodd III GD, Chintapalli KN. , et al. Radiofrequency thermal ablation of abdominal tumors: lessons learned from complications. Radiographics 2004; 24 (01) 41-52
• 8 Howenstein MJ, Sato KT. Complications of radiofrequency ablation of hepatic, pulmonary, and renal neoplasms. Semin Intervent Radiol 2010; 27 (03) 285-295
• 9 Shibata T, Yamamoto Y, Yamamoto N. , et al. Cholangitis and liver abscess after percutaneous ablation therapy for liver tumors: incidence and risk factors. J Vasc Interv Radiol 2003; 14 (12) 1535-1542
• 10 de Baère T, Risse O, Kuoch V. , et al. Adverse events during radiofrequency treatment of 582 hepatic tumors. AJR Am J Roentgenol 2003; 181 (03) 695-700
• 11 Shibata T, Yamamoto N, Ikai I. , et al. Choledochojejunostomy: possible risk factor for septic complications after percutaneous hepatic tumor ablation. AJR Am J Roentgenol 2000; 174 (04) 985-986
• 12 Okada S, Aoki K, Okazaki N. , et al. Liver abscess after percutaneous ethanol injection (PEI) therapy for hepatocellular carcinoma. A case report. Hepatogastroenterology 1993; 40 (05) 496-498
• 13 Akahane M, Koga H, Kato N. , et al. Complications of percutaneous radiofrequency ablation for hepato-cellular carcinoma: imaging spectrum and management. Radiographics 2005; 25 (01) (Suppl. 01) S57-S68
• 14 Spies JB, Rosen RJ, Lebowitz AS. Antibiotic prophylaxis in vascular and interventional radiology: a rational approach. Radiology 1988; 166 (02) 381-387
• 15 Rhim H, Yoon KH, Lee JM. , et al. Major complications after radio-frequency thermal ablation of hepatic tumors: spectrum of imaging findings. Radiographics 2003; 23 (01) 123-134 , discussion 134–136
• 16 Liang P, Wang Y, Yu X, Dong B. Malignant liver tumors: treatment with percutaneous microwave ablation--complications among cohort of 1136 patients. Radiology 2009; 251 (03) 933-940
• 17 Su XF, Li N, Chen XF, Zhang L, Yan M. Incidence and risk factors for liver abscess after thermal ablation of liver neoplasm. Hepat Mon 2016; 16 (07) e34588
• 18 Thomsen RW, Jepsen P, Sørensen HT. Diabetes mellitus and pyogenic liver abscess: risk and prognosis. Clin Infect Dis 2007; 44 (09) 1194-1201
• 19 Chehab MA, Thakor AS, Tulin-Silver S. , et al. Adult and pediatric antibiotic prophylaxis during vascular and IR procedures: a Society of Interventional Radiology Practice Parameter Update Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Association for Interventional Radiology. J Vasc Interv Radiol 2018; 29 (11) 1483-1501.e2
• 20 Hoffmann R, Rempp H, Schmidt D, Pereira PL, Claussen CD, Clasen S. Prolonged antibiotic prophylaxis in patients with bilioenteric anastomosis undergoing percutaneous radiofrequency ablation. J Vasc Interv Radiol 2012; 23 (04) 545-551
• 21 Odisio BC, Richter M, Aloia TA. , et al. Use of prophylactic antibiotics to prevent abscess formation following hepatic ablation in patients with prior enterobiliary manipulation. J Gastrointest Surg 2016; 20 (08) 1428-1434
• 22 Elias D, Di Pietroantonio D, Gachot B, Menegon P, Hakime A, De Baere T. Liver abscess after radiofrequency ablation of tumors in patients with a biliary tract procedure. Gastroenterol Clin Biol 2006; 30 (6-7): 823-827
• 23 Tan SL, Yu XL, Liang P. , et al. Preventing intrahepatic infection after ablation of liver tumours in biliary-enteric anastomosis patients. Int J Hyperthermia 2017; 33 (06) 664-669