Ishida Kota, Ushida Yuta, Minami Takayuki, Yamashita Yoriko, Inoue Masaya, Kato Takehiro, Sekoguchi Ei, Kurumiya Yasuhiro, Sugawara Gen
Department of Surgery, Toyota Kosei Hospital, 500-1 Josui-cho, Toyota, Aichi 470-0396, Japan.
Department of Pathology, Toyota Kosei Hospital, 500-1 Josui-cho, Toyota, Aichi 470-0396, Japan.
J Surg Case Rep. 2025 Jul 17;2025(7):rjaf532. doi: 10.1093/jscr/rjaf532. eCollection 2025 Jul.
Combined treatment with atezolizumab (ATZ) and bevacizumab (BV) is the first-line therapy for unresectable advanced hepatocellular carcinoma (HCC). We report a rare case of hepatocolic fistula during ATZ + BV therapy, successfully treated with salvage hepatectomy. A 72-year-old man with advanced HCC underwent treatment with ATZ + BV. After seven cycles, he presented with abdominal pain. Imaging revealed ascites and free air, leading to an emergency laparotomy, where panperitonitis was diagnosed. Despite lavage and drainage, postoperative fever persisted. Further imaging identified a liver abscess, requiring emergency ultrasound-guided percutaneous drainage. Contrast studies confirmed a hepatocolic fistula. The patient underwent ileostomy for abscess management, followed by extended posterior sectionectomy and right hemicolectomy on Day 25. He was discharged 37 days after final surgery without complications.
阿替利珠单抗（ATZ）联合贝伐单抗（BV）治疗是不可切除的晚期肝细胞癌（HCC）的一线治疗方案。我们报告了1例在ATZ + BV治疗期间发生肝结肠瘘的罕见病例，经挽救性肝切除成功治疗。1例72岁晚期HCC男性患者接受ATZ + BV治疗。7个周期后，他出现腹痛。影像学检查显示腹水和游离气体，遂行急诊剖腹探查术，术中诊断为弥漫性腹膜炎。尽管进行了冲洗和引流，但术后仍持续发热。进一步影像学检查发现肝脓肿，需要急诊超声引导下经皮引流。造影检查证实存在肝结肠瘘。患者接受了用于脓肿处理的回肠造口术，随后在第25天接受了扩大右后叶切除术和右半结肠切除术。最终手术后37天出院，无并发症。
