title: The complicated management of a patient following transarterial chemoembolization for metastatic carcinoid.
abstract: BACKGROUND
  Transarterial Chemoembolization (TACE) has been recognized as a successful way of managing symptomatic and/or progressive hepatic carcinoid metastases not amenable to surgical resection. Although it is a fairly safe procedure, it is not without its complications.
  
  
  METHODS
  This is a case of a 53 year-old woman with a patent foramen ovale (PFO) and mild pulmonary hypertension who underwent TACE for progressive carcinoid liver metastases. She developed acute heart failure, due to a severe inflammatory response; this resulted in pneumatosis intestinalis due to non-occlusive mesenteric ischemia. We describe the successful non-operative management of her pneumatosis intestinalis and the role of a PFO in this patient's heart failure.
  
  
  CONCLUSIONS
  TACE remains an effective and safe treatment for metastatic carcinoid not amenable to resection, this case illustrates the complexity of complications that can arise. A multi-disciplinary approach including ready access to advanced critical care facilities is recommended in managing such complex patients.
authors.affiliation: Department of Surgery, Ohio State University Medical Center, Columbus, Ohio, USA. willoperate4food@gmail.com
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Pearson
authors.forename: Steven
authors.initials: S
authors.lastname: Steinberg
authors.forename: Manisha H
authors.initials: MH
authors.lastname: Shah
authors.forename: Mark
authors.initials: M
authors.lastname: Bloomston
mesh_terms: D002276:Carcinoid Tumor / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications; D008113:Liver Neoplasms / Q000556:secondary* / Q000628:therapy*; D008875:Middle Aged; D011175:Positive-Pressure Respiration