Department of Radiology, Chonnam National University Hwasun Hospital and Chonnam National University Medical School, Hwasun-eup, Hwasun-gun, Jeollanam-do, South Korea.
Department of Radiology, Chonnam National University Hospital and Chonnam National University Medical School, Gwangju, South Korea.
Medicine (Baltimore). 2024 Sep 13;103(37):e39632. doi: 10.1097/MD.0000000000039632.
Owing to the abundant collateral blood supply to the duodenum, the development of a hepatoduodenal fistula after transarterial chemoembolization (TACE) is an extremely rare complication that usually requires hospitalization and intensive medical intervention. Here, we report a case of a silent hepatoduodenal fistula following TACE.
A 74-year-old man with a history of alcoholic liver cirrhosis and type 2 diabetes. He had undergone a partial hepatectomy due to hepatocellular carcinoma (HCC) 7 years ago. In addition, he had undergone 4 TACEs for the treatment of recurrent HCCs but still had a viable tumor in S4b of the liver, which abuts the duodenal 1st portion.
HCC.
The patient underwent a 5th TACE and was discharged from the hospital without major adverse events.
Follow-up computed tomography scans showed a 2 cm-sized air cavity instead of a compact Lipiodol-laden tumor in S4b, which had shrunk over time. The patient had experienced a fluctuating nonspecific mild fever for 3 months, with improvements in symptoms and laboratory findings following conservative treatment alone.
Hepatic fistulas may arise following TACE for HCCs near the gastrointestinal tract and may be present with nonspecific symptoms. This case suggests that increased efforts should be directed toward achieving selective embolization when treating HCC adjacent to the gastrointestinal tract, with close monitoring required after treatment.
由于十二指肠有丰富的侧支血液供应，经动脉化疗栓塞（TACE）后发生肝十二指肠瘘是一种极其罕见的并发症，通常需要住院和强化医疗干预。在这里，我们报告一例 TACE 后发生的无症状性肝十二指肠瘘。
一名 74 岁男性，有酒精性肝硬化和 2 型糖尿病病史。7 年前因肝细胞癌（HCC）行部分肝切除术。此外，他还接受了 4 次 TACE 治疗复发性 HCC，但仍有一个位于 S4b 段的存活肿瘤，紧邻十二指肠第 1 部分。
HCC。
患者接受了第 5 次 TACE，出院时无重大不良事件。
随访 CT 扫描显示 S4b 中 2 cm 大小的气腔而不是致密的载碘油肿瘤，肿瘤随时间缩小。患者出现波动的非特异性轻度发热 3 个月，经单纯保守治疗后症状和实验室检查改善。
TACE 治疗靠近胃肠道的 HCC 后可能会发生肝瘘，且可能出现非特异性症状。该病例提示，在治疗邻近胃肠道的 HCC 时，应更加努力实现选择性栓塞，并在治疗后进行密切监测。
