Kim Shin Il, Jin Young-Joo, Cho Soon Gu, Shin Woo Young, Kim Joon Mee, Lee Jin-Woo
Department of Internal Medicine Department of Radiology Department of Surgery Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea.
Medicine (Baltimore). 2016 Jul;95(27):e3987. doi: 10.1097/MD.0000000000003987.
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.
经动脉化疗栓塞术（TACE）常用于治疗无法切除的肝细胞癌（HCC），也可用于治疗直肠癌肝转移病例。尽管它被认为是一种安全有效的治疗方法，但各种并发症已有报道。然而，文献中尚未报道TACE术后十二指肠穿孔合并十二指肠和食管缺血的情况。一名43岁男性在因复发性不可切除的HCC接受8次重复TACE治疗后，出现十二指肠穿孔合并十二指肠和食管下段缺血，这在食管胃十二指肠镜检查和腹部计算机断层扫描中得到证实。有趣的是，手术所见显示除穿孔外十二指肠缺血完全恢复，并且他仅通过十二指肠节段切除术和胃空肠吻合术就康复了。我们报告了一例因不可切除的HCC接受第8次TACE治疗后出现十二指肠穿孔伴坏死和食管缺血的病例。尽管这种并发症罕见且出乎意料，但可能导致严重后遗症，需要手术修复。肝切除术后或重复TACE的患者在TACE期间需要谨慎操作，并在TACE后进行仔细监测，尤其是出现异常临床表现的情况。
