Korean J Gastroenterol.  2011 Sep;58(3):149-152. 10.4166/kjg.2011.58.3.149.

A Case of Hepaticoduodenal Fistula Development after Transarterial Chemoembolization in Patient with Hepatocellular Carcinoma

• Park YH
• Kang SH
• Kim SU
• Kim DY
• Park JY
• Ahn SH
• Han KH
• Chon CY

• KMID: 1018403
• DOI: http://doi.org/10.4166/kjg.2011.58.3.149

Abstract

Transarterial chemoembolization (TACE) is recommended as one of the first line therapy for unresectable hepatocellular carcinoma (HCC). Rupture of HCC following TACE is a rare and potentially fatal complication. We report a case of hepaticoduodenal fistula with ruptured HCC and liver abscess complicated by TACE. A 52-year-old male was treated by TACE three times, followed by radiation therapy and systemic chemotherapy. 30 days after the last TACE, right upper quadrant pain of abdomen was developed. About 1 month later, computed tomography of abdomen showed ruptured HCC with debris containing liver abscess and hepaticoduodenal fistula. Esophagogastroduodenoscopy revealed hepaticoduodenal fistula and hepatic parenchyme covered with exudate. The patient was managed with supportive care, but the hepaticoduodenal fistula persisted.

Keyword

Hepaticoduodenal fistula; Hepatocellular carcinoma; Transarterial chemoembolization

MeSH Terms

Carcinoma, Hepatocellular/radiotherapy/*therapy
Chemoembolization, Therapeutic/*adverse effects
Endoscopy, Digestive System
Gastric Fistula/*etiology
Humans
Liver Abscess/etiology
Liver Diseases/*etiology
Liver Neoplasms/radiotherapy/*therapy
Male
Middle Aged
Rupture, Spontaneous/etiology
Tomography, X-Ray Computed

Figure

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  Fig. 1. Huge hypervascular mass (12.3×9.5 cm) with central necrosis in the right lobe of the liver.

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  Fig. 2. One month after the last TACE, abdominal computed tomography revealed a ruptured of hepatocellular carcinoma at the S7 of the liver with abscess formation and fistular tract to the duodenum. TACE, transarterial chemoembolization.

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  Fig. 3. One month after the last TACE, esophagogastroduodenoscopy shows a fistula between the duodenal bulb and liver covered with exudate and parenchyme. TACE, transarterial chemoembolization.

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  Fig. 4. One month after the last TACE, upper gastrointestinal series revealed extraluminal contrast leakage suggesting hepaticoduodenal fistula. TACE, transarterial chemoembolization.

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  Fig. 5. One year after the last TACE, hepaticoduodenal fistula persisted in the esophgogastroduodenoscopy. TACE, transarterial chemoembolization.

Reference

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