Intrahepatic cholangiocarcinoma with aberrant hepatic artery presenting as hepatic abscess: a case report

Bing Li, Jingyuan Wang, Jianping Gong


Intrahepatic cholangiocarcinoma (ICC) is a primary hepatic malignancy that originates from epithelial cells of bile duct. Lack of diagnostic measures and therapies leads to an increasing number of deaths from ICC worldwide. Here we described a case of 61-year-old Chinese female, who initially presented with right upper quadrant pain, combined with the results that a low density mass accompanied by multiple nodules occupied the right liver lobe by CT-scan, which also showed an aberrant right hepatic artery that participated in the right liver lobe and origining from the superior mesenteric artery, this patient was clinically considered as hepatic abscess (HA). The patient’s right upper quadrant pain was alleviated after been treated with the infusion chemotherapy of the aberrant right hepatic artery (ARHA) via percutaneous femoral arterial catheterization by Seldinger technique (Meropenem 7 days) following the failure of the liver-puncture drainage.  However, the right upper quadrant pain occurred again 6 days later, serum CA19-9>1000.0 U/ml, which indicated the possibility of hepatic malignancy, so we performed laparotomy. The histopathological result of intraoperative frozen section demonstrated cholangiocarcinoma, unfortunately, it was unresectable. Finally, right lower lung pneumonia and pleural empyema happened to her and she succumbed to respiratory failure 22 days following surgery. In this report, we will discuss the case with reference to the literature.



Aberrant right hepatic artery, Hepatic abscess, Intrahepatic cholangiocarcinoma

Full Text:



Zhang H, Yang T, Wu M, Shen F. Intrahepatic cholangiocarcinoma: epidemiology, risk factors, diagnosis and surgical management. Cancer Lett. 2016;379(2):198-205.

Bridgewater J, Galle PR, Khan SA, Llovet JM, Park JW, Patel T, et al. Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma. J Hepatol. 2014;60(6):1268-89.

Affo S, Yu LX, Schwabe RF. The role of cancer-associated fibroblasts and fibrosis in liver cancer. Annu Rev Pathol. 2017;12:153-86.

Shah V, Arora A, Tyagi P, Sharma P, Bansal N, Singla V, et al. Intrahepatic cholangiocarcinoma masquerading as liver abscess. J Clin Exp Hepatol. 2015;5(1):89-92.

Gong ZJ, Cheng JW, Gao PT, Huang A, Sun YF, Zhou KQ, et al. Clinical characteristics and prognostic factors of patients with intrahepatic cholangiocarcinoma with fever: a propensity score matching analysis. Oncolog. 2019;24(7):997-1007.

Goto N, Yasuda I, Uematsu T, Kanemura N, Takao S, Ando K, et al. Intrahepatic cholangiocarcinoma arising 10 years after the excision of congenital extrahepatic biliary dilation. J Gastroenterol. 2001;36(12):856-62.

Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg. 1966;112:337-47.

Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg. 1994;220:50-2.

Cloyd JM, Chandra V, Louie JD, Rao S, Visser BC. Preoperative embolization of replaced right hepatic artery prior to pancreaticoduodenectomy. J Surg Oncol. 2012;106:509-12.

Ianora AA, Memeo M, Sabba C, Cirulli A, Rotondo A, Angelelli G. Hereditary hemorrhagic telangiectasia: multi-detector row helical CT assessment of hepatic involvement. Radiol. 2004;230(1):250-9.

McCorkell SJ, Niles NL. Pyogenic liver abscesses: another look at medical management. Lancet. 1985;1:803-6.

Herbert DA, Fogel DA, Rothman J, Wilson S, Simmons F, Ruskin J. Pyogenic liver abscesses: successful non-surgical therapy. Lancet. 1982;1:134-6.

Li C, Li G, Miao R, Lu X, Zhong S, Sang X, et al. Primary liver cancer presenting as pyogenic liver abscess: characteristics, diagnosis, and management. J Surg Oncol. 2012;105:687-91.

Keller JJ, Tsai MC, Lin CC, Lin YC, Lin HC. Risk of infections subsequent to pyogenic liver abscess: a nationwide population-based study. Clin Microbiol Infect. 2013;19:717-22.

Reddy G, Chatterjee A, Brott BC. Transdiaphragmatic rupture of hepatic abscess producing purulent pericarditis and pericardial tamponade. Circulation. 2015;131:1-2.

Xie ZY, Li LP, Wu WJ, Sun DY, Zhou MH, Zhao YG. Undifferentiated embryonal sarcoma of the liver mistaken for hepatic abscess in an adult. Oncol Lett. 2014;8:1184-6.

Zhou R, Zhang M, Cheng N, Zhou Y. Double primary hepatic cancer (hepatocellular carcinoma and intrahepatic cholangiocarcinoma) in a single patient: a case report. Oncol Lett. 2016;11:273-6.

Yonenaga Y, Kushihata F, Inoue H, Watanabe J, Tohyama T, Sugita A, et al. Sarcoidosis manifesting as hepatic and splenic nodules mimicking ovarian cancer metastases: A case report. Oncol Lett. 2015;10:2166-70.

Li C, Li G, Miao R, Lu X, Zhong S, Sang X, et al. Primary liver cancer presenting as pyogenic liver abscess: characteristics, diagnosis, and management. J Surg Oncol. 2012;105:687-91.