Glue embolization of a high output biliary fistula after RFA

A 74-year-old male with small bowel carcinoid tumor and multiple liver metastases underwent radiofrequency ablation of a segment 6 liver tumor. He developed high fevers thereafter and was admitted with sepsis 1 week after the ablation. Contrast-enhanced CT imaging demonstrated a large abscess in the right lobe with an air-fluid level (Fig. 66.1). A percutaneous drain was placed in the collection and the infection was controlled. The drain had a persistent daily bilious output of 100-200 cc for the preceding 10 days. A contrast abscessogram showed that the cavity communicated with biliary radicles (Fig. 66.2). Cone beam CT demonstrated a biliary fistula to the segment 6 radicles with no communication with the central bile ducts (Fig. 66.3).