Limits...
A lethal complication after transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma.

Toro A, Bertino G, Arcerito MC, Mannnino M, Ardiri A, Patane' D, Di Carlo I - Case Rep Surg (2015)

Bottom Line: Following the procedure the patient developed a hepatic abscess and biliobronchial fistula resulting in adult respiratory distress syndrome and death.Conclusion.We speculate that DEB-TACE has a prolonged effect on the tumor and the surrounding liver, resulting in progressive enlargement of the necrotic area.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania, Cannizzaro Hospital, 95100 Catania, Italy.

ABSTRACT
Background. The current standard of care for patients with large or multinodular noninvasive hepatocellular carcinoma is conventional transarterial chemoembolization (TACE). TACE may also be performed with drug-eluting beads, but serious complications of this procedure have been reported. Methods. Aim of this report is to present a patient affected by multifocal HCC who underwent TACE with drug-eluting bead (DEB-TACE). Results. Following the procedure the patient developed a hepatic abscess and biliobronchial fistula resulting in adult respiratory distress syndrome and death. Conclusion. We speculate that DEB-TACE has a prolonged effect on the tumor and the surrounding liver, resulting in progressive enlargement of the necrotic area. This activity that can extend to the surrounding healthy hepatic tissues may continue indefinitely.

No MeSH data available.


Related in: MedlinePlus

CT image at 28 d after TACE with DC beads. (a) CT image showing a huge abscess in the right lobe of the liver. (b) Many small hypodense areas are located mostly in segments 4, 6, 7, and 8 of the liver.
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4353438&req=5

fig2: CT image at 28 d after TACE with DC beads. (a) CT image showing a huge abscess in the right lobe of the liver. (b) Many small hypodense areas are located mostly in segments 4, 6, 7, and 8 of the liver.

Mentions: Twenty-eight days after the procedure, he returned to our department with right upper quadrant abdominal pain and fever (39°C). Abdominal CT showed a large hypodense area in the right lobe of the liver measuring 78 mm × 82 mm (Figure 2(a)) and multiple small hypodense areas throughout the right lobe, especially in segments 4, 6, 7, and 8 (Figure 2(b)). He was admitted to hospital, and a CT-guidance percutaneous 10-Fr drainage catheter was placed in the large hepatic abscess. Antibiotics (metronidazole plus tazobactam) and paracetamol were administered. His fever and pain resolved within 48 h. As the catheter continued to drain a small amount of purulent necrotic material, it was left in place after discharge and he was seen daily in the output clinic. The drainage stopped after 2 wk, and after repeat ultrasonography the catheter was removed.


A lethal complication after transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma.

Toro A, Bertino G, Arcerito MC, Mannnino M, Ardiri A, Patane' D, Di Carlo I - Case Rep Surg (2015)

CT image at 28 d after TACE with DC beads. (a) CT image showing a huge abscess in the right lobe of the liver. (b) Many small hypodense areas are located mostly in segments 4, 6, 7, and 8 of the liver.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4353438&req=5

fig2: CT image at 28 d after TACE with DC beads. (a) CT image showing a huge abscess in the right lobe of the liver. (b) Many small hypodense areas are located mostly in segments 4, 6, 7, and 8 of the liver.
Mentions: Twenty-eight days after the procedure, he returned to our department with right upper quadrant abdominal pain and fever (39°C). Abdominal CT showed a large hypodense area in the right lobe of the liver measuring 78 mm × 82 mm (Figure 2(a)) and multiple small hypodense areas throughout the right lobe, especially in segments 4, 6, 7, and 8 (Figure 2(b)). He was admitted to hospital, and a CT-guidance percutaneous 10-Fr drainage catheter was placed in the large hepatic abscess. Antibiotics (metronidazole plus tazobactam) and paracetamol were administered. His fever and pain resolved within 48 h. As the catheter continued to drain a small amount of purulent necrotic material, it was left in place after discharge and he was seen daily in the output clinic. The drainage stopped after 2 wk, and after repeat ultrasonography the catheter was removed.

Bottom Line: Following the procedure the patient developed a hepatic abscess and biliobronchial fistula resulting in adult respiratory distress syndrome and death.Conclusion.We speculate that DEB-TACE has a prolonged effect on the tumor and the surrounding liver, resulting in progressive enlargement of the necrotic area.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania, Cannizzaro Hospital, 95100 Catania, Italy.

ABSTRACT
Background. The current standard of care for patients with large or multinodular noninvasive hepatocellular carcinoma is conventional transarterial chemoembolization (TACE). TACE may also be performed with drug-eluting beads, but serious complications of this procedure have been reported. Methods. Aim of this report is to present a patient affected by multifocal HCC who underwent TACE with drug-eluting bead (DEB-TACE). Results. Following the procedure the patient developed a hepatic abscess and biliobronchial fistula resulting in adult respiratory distress syndrome and death. Conclusion. We speculate that DEB-TACE has a prolonged effect on the tumor and the surrounding liver, resulting in progressive enlargement of the necrotic area. This activity that can extend to the surrounding healthy hepatic tissues may continue indefinitely.

No MeSH data available.


Related in: MedlinePlus