{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T22:14:31Z","timestamp":1773440071211,"version":"3.50.1"},"reference-count":12,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2023,10,26]],"date-time":"2023-10-26T00:00:00Z","timestamp":1698278400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Chosun University","award":["2021R1A2C2004299"],"award-info":[{"award-number":["2021R1A2C2004299"]}]},{"name":"Chosun University","award":["2021R1I1A3050277"],"award-info":[{"award-number":["2021R1I1A3050277"]}]},{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea (NRF)","doi-asserted-by":"publisher","award":["2021R1A2C2004299"],"award-info":[{"award-number":["2021R1A2C2004299"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea (NRF)","doi-asserted-by":"publisher","award":["2021R1I1A3050277"],"award-info":[{"award-number":["2021R1I1A3050277"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>We present the first documented case of a fistula between the treated zone and the appendix after RFA in a patient with HCC. Contrast-enhanced CT and MRI revealed a subcapsular hepatic nodule with image findings of HCC located adjacent to the ascending colon and cecum. An ultrasound-guided core needle biopsy was subsequently performed to distinguish between hepatic metastasis and HCC. Post-RFA imaging identified a low-attenuating ablated area adjacent to an air-filled appendix. The patient later experienced complications, including increased liver enzymes and an abscess at the ablation site. Imaging revealed a fistulous tract between the RFA zone and the appendix. Over the following months, the patient underwent conservative treatment involving intravenous antibiotics and repeated percutaneous drainage, exhibiting eventual symptom relief and an absence of the fistulous tract upon subsequent imaging. This case highlights the rare complications that can arise during RFA due to peculiar anatomical variations, such as a subhepatic appendix, resulting from midgut malrotation and previous surgery. It is imperative for operators to be cognizant of potential anatomical variations when considering RFA treatment, ensuring comprehensive pre-procedural imaging and post-procedure monitoring. This case also emphasizes the potential viability of nonoperative management in complex scenarios in which surgical interventions pose significant risks.<\/jats:p>","DOI":"10.3390\/diagnostics13213322","type":"journal-article","created":{"date-parts":[[2023,10,27]],"date-time":"2023-10-27T09:56:36Z","timestamp":1698400596000},"page":"3322","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Thermal Injury to the Subhepatic Appendix Following Percutaneous Ultrasound-Guided Radiofrequency Ablation for Hepatocellular Carcinoma: A Case Report"],"prefix":"10.3390","volume":"13","author":[{"given":"Eun Ju","family":"Yoon","sequence":"first","affiliation":[{"name":"Department of Radiology, Chosun University Hospital and Chosun University College of Medicine, Gwangju 61453, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4725-5687","authenticated-orcid":false,"given":"Jin Woong","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Radiology, Chosun University Hospital and Chosun University College of Medicine, Gwangju 61453, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun Hyung","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Radiology, Chosun University Hospital and Chosun University College of Medicine, Gwangju 61453, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sang Gook","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Radiology, Chosun University Hospital and Chosun University College of Medicine, Gwangju 61453, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyun Chul","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Radiology, Chosun University Hospital and Chosun University College of Medicine, Gwangju 61453, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Young Hoe","family":"Hur","sequence":"additional","affiliation":[{"name":"Department of Hepato-Biliary-Pancreas Surgery, Chonnam National University Hwasun Hospital and Chonnam National University Medical School, Gwangju 61469, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7591-9079","authenticated-orcid":false,"given":"Hyung Joong","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Kyung Hee University, Seoul 02447, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.3348\/kjr.2015.16.6.1226","article-title":"Ultrasound-guided percutaneous radiofrequency ablation of liver tumors: How we do it safely and completely","volume":"16","author":"Kim","year":"2015","journal-title":"Korean J. Radiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1097\/01.sla.0000118373.31781.f2","article-title":"Early and late complications after radiofrequency ablation of malignant liver tumors in 608 patients","volume":"239","author":"Curley","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2651","DOI":"10.3748\/wjg.15.2651","article-title":"Major complications after radiofrequency ablation for liver tumors: Analysis of 255 patients","volume":"15","author":"Kong","year":"2009","journal-title":"World J. Gastroenterol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1007\/s00261-017-1239-8","article-title":"Gastrointestinal tract complications after hepatic radiofrequency ablation: CT prediction for major complications","volume":"43","author":"Jeong","year":"2018","journal-title":"Abdom. Radiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2319","DOI":"10.1245\/s10434-006-9220-8","article-title":"Percutaneous radiofrequency ablation for recurrent hepatocellular carcinoma after hepatectomy: Long-term results and prognostic factors","volume":"14","author":"Choi","year":"2007","journal-title":"Ann. Surg. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1002\/bjs.5374","article-title":"Artificial ascites technique for percutaneous radiofrequency ablation of liver cancer adjacent to the gastrointestinal tract","volume":"93","author":"Kondo","year":"2006","journal-title":"Br. J. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/S0039-6109(05)70407-2","article-title":"Appendix and cecum: Embryology, anatomy, and surgical applications","volume":"80","author":"Schumpelick","year":"2000","journal-title":"Surg. Clin. N. Am."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1186\/1752-1947-2-339","article-title":"Subhepatically located appendicitis due to adhesions: A case report","volume":"2","author":"Ting","year":"2008","journal-title":"J. Med. Case Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.jcol.2015.08.003","article-title":"Vermiform appendix: Positions and length-a study of 377 cases and literature review","volume":"35","year":"2015","journal-title":"J. Coloproctol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1177\/000313481608200107","article-title":"A systematic review of perforated appendicitis and phlegmon: Interval appendectomy or wait-and-see?","volume":"82","author":"Darwazeh","year":"2016","journal-title":"Am. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1016\/j.amjsurg.2018.12.061","article-title":"Complicated appendicitis: Immediate operation or trial of nonoperative management?","volume":"217","author":"Nimmagadda","year":"2019","journal-title":"Am. J. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1097\/TA.0000000000000187","article-title":"Predictive factors for failure of nonoperative management in perforated appendicitis","volume":"76","author":"Maxfield","year":"2014","journal-title":"J. Trauma Acute Care Surg."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/21\/3322\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:12:21Z","timestamp":1760130741000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/21\/3322"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,26]]},"references-count":12,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2023,11]]}},"alternative-id":["diagnostics13213322"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13213322","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,26]]}}}