Korean J Gastroenterol.  2020 Jun;75(6):351-355. 10.4166/kjg.2020.75.6.351.

Gallbladder Perforation after Transarterial Chemoembolization in a Patient with a Huge Hepatocellular Carcinoma

• Son MY
• Han BH
• Lee SU
• Yun BC
• Seo KI
• Huh JD

• KMID: 2504378
• DOI: http://doi.org/10.4166/kjg.2020.75.6.351

Abstract

Transarterial chemoembolization (TACE) is a common treatment for unresectable hepatocellular carcinoma (HCC). The most common complications after TACE are non-specific symptoms called post-embolization syndrome, such as abdominal pain or fever. Rare complications, such as liver failure, liver abscess, sepsis, pulmonary embolism, cholecystitis, can also occur. On the other hand, gallbladder perforation is quite rare. This paper reports a case of gallbladder perforation following TACE. A 76-year-old male with a single 9-cm-sized HCC underwent TACE. Five days after TACE, he developed persistent right upper quadrant pain and ileus. An abdomen CT scan confirmed gallbladder perforation with bile in the right paracolic gutter and pelvic cavity. Percutaneous transhepatic gallbladder drainage was performed with the intravenous administration of antibiotics. After 1 month, the patient underwent right hemihepatectomy and cholecystectomy. Physicians should consider the possibility of gallbladder perforation, which is a rare complication after TACE, when unexplained abdominal pain persists.

Keyword

Gallbladder; Rupture; Chemoembolization, therapeutic; Carcinoma, hepatocellular

Figure

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  Fig. 1 Triple phase computed tomography of the liver at diagnosis. (A) A 9 cm sized heterogeneous enhancing mass of the right hepatic lobe at the arterial phase (white arrow). (B) The heterogeneous enhancing mass is washed out, showing low density at the portal and (C) delayed phase (white arrows).

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  Fig. 2 Transarterial chemoembolization (TACE) of the hepatocellular carcinoma. Right hepatic angiography shows (A) huge hypervascular mass in the right hepatic lobe (white arrow), (B) super selection of supplying branches of the right hepatic artery by microcatheter (white arrow), and (C) complete embolization (white arrow).

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  Fig. 3 X-ray of the abdomen at 5 days after the transarterial chemoembolization. X-ray findings show the generalized distension of small and large intestine.

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  Fig. 4 Contrast-enhanced computed tomography (CT) at 7 days after the transarterial chemoembolization. (A) Axial and (B) coronal CT images show the perforation of the gallbladder with bile (white arrows) in the right paracolic gutter and pelvic cavity.

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  Fig. 5 Right hepatic angiography. The tip of the microcatheter (white arrow) is located beyond the cystic artery (black arrow) but is close between the microcatheter's tip and cystic artery.

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