Hemobilia after radiofrequency ablation of hepatocellular carcinoma

Objective: The purpose of this study was to report on the clinical course and imaging findings of hemobilia after radiofrequency (RF) ablation in four patients with hepatocellular carcinoma (HCC). Materials and methods: From July 2000 to December 2005, we experienced four cases of hemobilia after 1574 sessions of ultrasonography (US)-guided RF ablation in 1037 patients with HCCs. All ablation procedures were percutaneously performed with an internally cooled RF electrode system. The diagnosis of hemobilia was made if the patient complained of melena after RF ablation and biliary dilatation with high attenuating bile was noted at CT obtained immediately after RF ablation. We evaluated the clinical course and imaging findings of hemobilia caused by RF ablation. Results: All patient well tolerated RF ablation procedures without any incident during the procedure. Three of four patients complained of melena with an interval from 1 day to 4 days after RF ablation. One patient was asymptomatic. The melena symptom in all symptomatic patients spontaneously improved in 2 days. None of the patients showed substantial change in vital sign and the level of hemoglobin during the admission period. In all four patients, biliary (including GB) dilatation with high attenuating bile was noted at immediate follow-up CT. The CT findings in all four patients disappeared at 1 month follow-up CT. Conclusion: Hemobilia is a rare potential complication of RF ablation with a favorable prognosis. Clinicians who use this technique should be aware of the characteristic CT findings and clinical course of hemobilia after RF ablation for liver tumors.