Chintalapati Sai Pavan, Patel Arpan, Conjeevaram Hari
Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA.
BMJ Case Rep. 2018 Feb 21;2018:bcr-2017-223339. doi: 10.1136/bcr-2017-223339.
Transarterial chemoembolisation (TACE) is commonly used for unresectable intermediate-stage hepatocellular carcinoma (HCC). TACE is usually well-tolerated. We report a case of a patient who presented with a gastrointestinal bleed from TACE. A 64-year-old man presented with chronic hepatitis C cirrhosis and multifocal bilobar HCC. He had previously undergone multiple TACE sessions, radiofrequency ablation and stereotactic body radiation therapy. In the evening of his TACE procedure, he developed abdominal pain and haematemesis. An oesophagogastroduodenoscopy (OGD) showed non-bleeding oesophageal varices and ulcerations in the stomach and duodenum, with pathology demonstrating mucosal necrosis. The patient recovered and was discharged on omeprazole. While TACE is considered safe with most patients only experiencing postembolisation syndrome, vascular complications have been reported. In our patient, OGD revealed ulcerations, with biopsies confirming ischaemic ulceration. The likely aetiology was seepage of the embolic particles into neighbouring arteries. Patients should be carefully selected for TACE and monitored post procedure.
经动脉化疗栓塞术（TACE）常用于不可切除的中期肝细胞癌（HCC）。TACE通常耐受性良好。我们报告一例患者，其因TACE出现胃肠道出血。一名64岁男性，患有慢性丙型肝炎肝硬化和多灶性双叶HCC。他此前曾接受多次TACE治疗、射频消融和立体定向体部放射治疗。在TACE治疗当晚，他出现腹痛和呕血。食管胃十二指肠镜检查（OGD）显示食管静脉曲张无出血，胃和十二指肠有溃疡，病理显示黏膜坏死。患者康复，出院时服用奥美拉唑。虽然大多数患者认为TACE安全，仅经历栓塞后综合征，但也有血管并发症的报道。在我们的患者中，OGD显示有溃疡，活检证实为缺血性溃疡。可能的病因是栓塞颗粒渗入邻近动脉。应谨慎选择接受TACE的患者，并在术后进行监测。
