title: Duodenal perforation and esophageal ischemia following transarterial chemoembolization for hepatocellular carcinoma: A case report.
abstract: Transarterial chemoembolization (TACE) is frequently used for treatment of unresectable hepatocellular carcinoma (HCC) and can also be used for case of liver metastases from rectal cancer. Although it is recognized as safe and effective treatment, various complications have been reported. However, post-TACE duodenal perforation with duodenal and esophageal ischemia has not been reported in the literature. A 43-year-old male had experienced duodenal perforation combined with duodenal and lower esophageal ischemia after 8 times of repeated TACE for recurrent and unresectable HCCs, that was confirmed on esophagogastroduodenoscopy and abdominal computed tomography. Interestingly, operative findings showed complete recovery of duodenal ischemia except perforation, and he recovered with just the segmental duodenectomy and gastrojejunostomy. We report a case of duodenal perforation with necrosis and esophageal ischemia after 8th TACE for unresectable HCC. Although this complication is rare and unexpected, it may result in severe sequelae requiring surgical repair.The careful procedure during TACE followed by post-TACE careful monitoring is required in patients with posthepatectomy or repeated TACE, especially in the case with unusual clinical manifestations.
authors.affiliation: Department of Internal Medicine Department of Radiology Department of Surgery Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea.
authors.forename: Shin Il
authors.initials: SI
authors.lastname: Kim
authors.forename: Young-Joo
authors.initials: YJ
authors.lastname: Jin
authors.forename: Soon Gu
authors.initials: SG
authors.lastname: Cho
authors.forename: Woo Young
authors.initials: WY
authors.lastname: Shin
authors.forename: Joon Mee
authors.initials: JM
authors.lastname: Kim
authors.forename: Jin-Woo
authors.initials: JW
authors.lastname: Lee
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects* / Q000379:methods; D004378:Duodenal Diseases / Q000209:etiology*; D004947:Esophagus / Q000098:blood supply*; D006499:Hepatic Artery; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology*; D007511:Ischemia / Q000209:etiology*; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male