Extensive hepatic necrosis after transarterial chemoembolization

Excerpt

A 62-year-old man with a metastatic hepatic carcinoid tumor originating from the distal ileum underwent transarterial chemoembolization (TACE) of the right hepatic artery with cisplatin, adriamycin, and mitomycin C (Fig. 1). Four days later, patient had a sudden change in mental status, generalized weakness, and intractable vomiting. On examination, patient was jaundiced, hypotensive, and febrile. The abdomen was non-distended and non-tender, and the liver was not palpable. Patient was septic with markedly elevated liver enzymes. Computed tomography scan of the abdomen showed a wedge-shaped distribution of abnormal gas collections concentrated into the right lobe corresponding to the site of TACE (Fig. 2). Heterogeneity with diminished attenuation suggested necrosis of the chemoembolized metastatic tumor. The portal vein was patent. Blood cultures grew Gram-positive bacteria, and the patient was treated with antibiotics. Patient was not a surgical candidate due to the extent of hepatic necrosis and eventually died of multiorgan failure as a result of sepsis. CT scan immediately after TACE may reveal small amounts of intrahepatic gas as a result of necrosis from ischemic liver damage [1]. Liver failure and sepsis may occur with extensive liver necrosis [1]. Physicians must be very cautious in performing hepatic TACE, especially in patients with large volume liver metastasis [2].

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