Chennavasin Papawee, Phoopat Jatuporn, Udomchaisakul Preechapon, Gururatsakul Montri
Department of Surgery, Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok 10210, Thailand.
Department of Surgery, Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok 10210, Thailand.
Int J Surg Case Rep. 2023 Mar;104:107965. doi: 10.1016/j.ijscr.2023.107965. Epub 2023 Mar 4.
Transarterial chemoembolization (TACE) is widely employed to control acute bleeding in ruptured hepatocellular carcinoma (rHCC). Ischemia leading to perforation of the gastrointestinal tract (GIT) after TACE is a rare complication. We report a patient who presented with rHCC and who suffered gastric perforation post-TACE.
A 70-year-old woman presented with rHCC. Emergency TACE was undertaken to control bleeding, and was successful. The patient was discharged 5 days post TACE. Two weeks after TACE, she presented with acute abdominal pain. Computed tomography of the abdomen showed perforation at the lesser curvature of the stomach. The angiogram from TACE was reviewed: the small vessels from an accessory branch of the left gastric artery originating from the left hepatic artery that had been embolized were likely responsible for gastric ischemia and subsequent perforation. The patient underwent operation with simple closure and omental patch repair. Postoperative gastric leak was not observed. Unfortunately, the patient died due to severe decompensated liver disease ∼4 weeks after TACE.
Gastrointestinal tract (GIT) perforation after TACE is a rare complication. We suspected that perforation of the lesser curve of the stomach was secondary to ischemia due to non-target embolization to the accessory branch of the left gastric artery from the left hepatic artery, combined with stress and hemodynamic instability from rHCC.
rHCC is a life-threatening condition. Variation in vascular structures must be clarified carefully. Significant adverse events in the GIT post-TACE are rare, but high-risk patients must be cautiously monitored.
经动脉化疗栓塞术（TACE）被广泛用于控制破裂肝细胞癌（rHCC）的急性出血。TACE后导致胃肠道（GIT）穿孔的缺血是一种罕见的并发症。我们报告了一名患有rHCC且在TACE后发生胃穿孔的患者。
一名70岁女性患有rHCC。为控制出血进行了紧急TACE，手术成功。患者在TACE后5天出院。TACE两周后，她出现急性腹痛。腹部计算机断层扫描显示胃小弯处穿孔。回顾了TACE的血管造影：来自左肝动脉发出的左胃动脉副支的小血管被栓塞，这可能是导致胃缺血及随后穿孔的原因。患者接受了单纯缝合和网膜补片修补手术。术后未观察到胃漏。不幸的是，患者在TACE后约4周因严重失代偿性肝病死亡。
TACE后胃肠道（GIT）穿孔是一种罕见的并发症。我们怀疑胃小弯穿孔是由于左肝动脉对左胃动脉副支的非靶栓塞导致的缺血，再加上rHCC引起的应激和血流动力学不稳定所致。
rHCC是一种危及生命的疾病。必须仔细明确血管结构的变异情况。TACE后GIT发生重大不良事件虽罕见，但对高危患者必须谨慎监测。
