Surgical treatment of bronchobiliary fistula due to radiofrequency ablation for recurrent hepatocellular carcinoma

Bronchobiliary fistula (BBF) is a rare complication of radiofrequency ablation (RFA), in which there is abnormal communications between the biliary tract and the bronchial trees. Surgery should only be considered for BBF when non-invasive interventions have failed. In this report, we describe the surgical management for BBF when complicated by an abscess that was encountered after RFA in a 52-year-old woman with recurrent hepatocellular carcinoma (HCC). She had previously undergone central bisectionectomy of HCC 7 years ago, and had been treated with a sixth transarterial chemoembolization and first RFA for recurrent HCC after the operation. After the liver abscess and BBF occurred in the posterior section of the liver, she received posterior sectionectomy and hepaticojejunostomy, drainage of the lung abscess, diaphragmatic resection and repair because it was impossible to drain the abscess radiologically. Symptomatic improvements were being achieved through operative treatments where pleural effusion and pneumonic consolidation was obliterated on a 2-months follow-up image.