Korean J Radiol.  2009 Apr;10(2):197-201. 10.3348/kjr.2009.10.2.197.

Acute Obstructive Cholangitis after Transarterial Chemoembolization: the Effect of Percutaneous Transhepatic Removal of Tumor Fragment

• Choi KH
• Cho YK
• An JK
• Woo JJ
• Kim HS
• Choi YS

• KMID: 1088733
• DOI: http://doi.org/10.3348/kjr.2009.10.2.197

Abstract

Acute obstructive cholangitis due to the migration of necrotized tumor fragment is a rare complication occurring after a transarterial chemoembolization. The percutaneous tumor removal procedure following percutaneous transhepatic biliary drainage is an appropriate treatment over endoscopic removal for the relief of acute cholangitis in this case. Following this serial management, no invasive hepatocellular carcinoma of the bile duct recurred after two years of follow-up.

Keyword

Liver neoplasms, therapy; Liver neoplasms, chemotherapeutic; Liver neoplasms, percutaneous transhepatic biliary drainage

MeSH Terms

Acute Disease
Bile Duct Neoplasms/pathology/therapy
Bile Ducts, Intrahepatic
Carcinoma, Hepatocellular/pathology/therapy
*Catheterization
Chemoembolization, Therapeutic/*adverse effects/methods
Cholangiography
Cholangitis/*etiology/therapy
Drainage
Humans
Jaundice, Obstructive/*etiology/therapy
Liver Neoplasms/pathology/therapy
Male
Middle Aged
Neoplasm Invasiveness
Neoplasm, Residual

Figure

• 

  Fig. 1 Acute obstructive cholangitis after transarterial chemoembolization in 62-year-old male. A. Initial abdominal CT scan shows ovoid-shaped, highly enhancing invasive intraductal hepatocellular carcinoma in proximal common hepatic duct and left hepatic duct with ductal dilation (black arrow). B. Selective left hepatic angiography performed during initial transcatheter arterial chemoembolization showed ill-defined, tumor staining along proximal common hepatic duct and left hepatic duct (black arrows). Tumor staining occurred in identical location of bile duct invasion on CT image. C. Follow-up abdominal CT performed one week after initial transcatheter arterial chemoembolization showed multifocal, dense lipiodol deposits within proximal common hepatic duct and left hepatic duct after initial transcatheter arterial chemoembolization (black arrow). We also found small, faint, parenchymal lipiodol deposits in peripheral portion of left lobe. D. Follow-up abdominal CT performed two weeks after initial transcatheter arterial chemoembolization showed acutely dilated proximal common bile duct and left hepatic duct without visualization of previous lipiodol deposits at same level (black arrow). E. Same abdominal CT showed distally migrated, dense lipiodolized tumor fragments in distal common bile duct (black arrow), which was completely obstructed in distal common bile duct and resulted in dilatation of proximal common bile duct, left hepatic duct, and gallbladder. F. Percutaneous transhepatic biliary drainage was performed for treatment of obstructive jaundice. Cholangiography of percutaneous transbiliary drainage showed ovoid, large filling defect in distal common bile duct with complete obstruction of distal passage of contrast (black arrow). G. Final cholangiography performed after these procedures showed complete disappearance of tumor fragment in distal common bile duct, restoration of contrast passage into duodenum, and decompressed biliary tree (black arrow).

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