PMC3932379_01
Serial contrast-enhanced computed tomography findings. (A) A gas-containing cavity is seen, suggestive of an abscess within a necrotic mass in the left lateral segment of the liver. (B) Communication between the liver abscess cavity and the duodenal bulb is present (arrows). (C) The fistulous tract is obliterated and the extent of the abscess has decreased.
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F1
Abdominal computed tomography (CT) showed a gas-containing cavity suggestive of an abscess within a necrotic mass in the left lateral segment of the liver (Fig. 1A). Although the abscess had decreased in size, we detected a new communication between the remaining abscess and the duodenal bulb (Fig. 1B). One month after the intervention, a follow-up abdominal CT scan showed obliteration of the fistulous tract and a decrease in the extent of the abscess (Fig. 1C).
Endoscopic findings. (A) The fistula orifice is seen at the proximal portion of the duodenal bulb. (B) The fistula opening remains visible beside the clips. (C) The fistula orifice is filled with Histoacryl after Histoacryl injection.
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F2
Gastroduodenoscopy was performed to confirm the fistula through a 0.3-cm hole in the proximal portion of the duodenal bulb (Fig. 2A). Follow-up endoscopy was performed 2 days after clipping; however, there was still a fistula opening beside the clips (Fig. 2B). Follow-up endoscopy performed 2 days after this intervention revealed that the previous fistula orifice was filled with Histoacryl (Fig. 2C).
The clinical course of the patient from the time of hepatocellular carcinoma (HCC) diagnosis.. RT, radiation therapy; TACE, transcatheter arterial chemoembolization.
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F3
TACE without abscess recurrence (Fig. 3).