Hepatocolic fistula in hepatocellular carcinoma treated with atezolizumab-bevacizumab: a case report on successful salvage hepatectomy.

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.