Ultrasound-Guided Salvage RFA for HCC Post-Microwave Ablation with Gas Gangrene: Case Report

Gas gangrene (GG) is a rare but highly fatal infection, typically associated with Clostridium species, which often develops as a sudden and severe complication following abdominal surgery or liver transplantation. This report presents a unique case where GG of the liver developed after percutaneous microwave (MW) ablation of hepatocellular carcinoma (HCC) and was successfully treated using percutaneous radiofrequency ablation (RFA). The case involved a 76-year-old female patient who initially underwent MW ablation to treat a large HCC located in segment VIII of the liver. Two days post-procedure, she began experiencing fever, weakness, and abdominal swelling, and was soon hospitalized with a diagnosis of anaerobic liver abscess. Despite initiation of antibiotic therapy, her condition continued to deteriorate, leading to her admission to the intensive care unit (ICU). Attempts to manage the infection through percutaneous drainage proved unsuccessful, and surgical intervention was deemed unviable due to the patient’s critical condition. At this point, percutaneous RFA was considered as an alternative treatment. Utilizing three cool-tip needles, RFA was performed directly on the infected region, targeting the gas gangrene effectively. The patient tolerated the procedure well, and her condition improved significantly, allowing for discharge and ongoing follow-up. This case highlights the potential of percutaneous RFA as an effective salvage therapy for focal GG of the liver, particularly in cases unresponsive to antibiotics and where surgical or liver transplantation options are unfeasible. Early intervention with RFA may be crucial for managing rapid deterioration in patients with liver GG.