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Colon Perforation Secondary to Radiofrequency Ablation of Hepatic Tumor
經無線射頻肝腫瘤治療所引起之大腸穿孔
摘要
無線射頻燒灼術已經是廣泛地應用在原發或次發之肝腫瘤。雖然無線射頻燒灼術已被認為是安全且有效率之肝癌腫瘤局部治療法，但臨床上仍需注意到一些嚴重的併發症。 本案例是位患有鼻咽癌合併肝轉移之個案，經轉介至放射科做無線射頻燒灼術之治療。持續性的腹部疼痛至術後第四天變成全腹反彈式壓痛。腹部電斷層指出有腹腔積氣伴隨著液體及滲透顯影在右側大腸周圍及腸繫膜脂肪。影像學檢查判定為因無線射頻燒灼術所引起之大腸穿孔，病人立刻進行右半側之大腸切除，而病理組織證實為位於肝迴轉大腸之穿孔並伴隨有網膜壞死。 病人術後平順地恢復，除了一些間隔性地發燒及貧血。在經抗生素及輸血治療後，病人於住院後第13天出院。 在我們這次所報告之因無線射頻燒灼所引起之腸穿孔中，我們須再次強調術前之病人評估及篩選的重要性。而放射科醫師也必須熟稔各種影像特徵,才能做早期診斷並給予適當處置。
並列摘要
We present a case of nasopharyngeal carcinoma, which was treated by radiotherapy combined with chemotherapy. Hepatic metastases was noted, and thus referred to our department for Radiofrequency (RF) ablation therapy. Pain was noted after the procedure and was given analgesics. However, the pain persisted with direct and rebound tenderness over the whole abdomen on the 4th day after ablation. CT scan of the abdomen revealed focal free air and inflammatory strandings on the right pericolic and adjacent mesenteric fat plane associated with mucosal disruption at the hepatic flexure of colon. Iatrogenic colon perforation secondary to RF ablation was diagnosed and he underwent right hemicolectomy with side-to-side anastomosis. Post-operative course was smooth except of intermittent fever and anemia. Antiobiotic therapy and blood transfusion were given and he was discharged as improved 13th days post-operatively. We report a case of colon perforation secondary to RF ablation of metastatic hepatic tumor. We emphasize that the performing physician should be aware and careful selection of patient is necessary to avoid this complication. The radiologist must be familiar with the various imaging features of this complication for early diagnosis and appropriate management.