A Case of Hepaticoduodenal Fistula Development after Transarterial Chemoembolization in Patient with Hepatocellular Carcinoma

Yoon Hea Park; Se Hun Kang; Seung Up Kim; Do Young Kim; Jun Yong Park; Sang Hoon Ahn; Kwang-Hyub Han; Chae Yoon Chon

doi:10.4166/kjg.2011.58.3.149

Journal List > Korean J Gastroenterol > v.58(3) > 1006852

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Park, Kang, Kim, Kim, Park, Ahn, Han, and Chon: A Case of Hepaticoduodenal Fistula Development after Transarterial Chemoembolization in Patient with Hepatocellular Carcinoma

Case Report

Korean J Gastroenterol 2011;58(3):149-152.

Published online: 4 October 2011

DOI: https://doi.org/10.4166/kjg.2011.58.3.149

A Case of Hepaticoduodenal Fistula Development after Transarterial Chemoembolization in Patient with Hepatocellular Carcinoma

Yoon Hea Park, Se Hun Kang, Seung Up Kim, Do Young Kim, Jun Yong Park, Sang Hoon Ahn, Kwang-Hyub Han, Chae Yoon Chon

Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea

Correspondence to: Do Young Kim, Department of Internal Medicine, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea. Tel: +82-2-2228-1992, Fax: +82-2-393-6884, E-mail: dyk1025@yuhs.ac

Received 7 April 2011 Accepted 20 May 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Transarterial chemoembolization (TACE) is recommended as one of the first line therapy for unresectable hepatocellular carcinoma (HCC). Rupture of HCC following TACE is a rare and potentially fatal complication. We report a case of hepaticoduodenal fistula with ruptured HCC and liver abscess complicated by TACE. A 52-year-old male was treated by TACE three times, followed by radiation therapy and systemic chemotherapy. 30 days after the last TACE, right upper quadrant pain of abdomen was developed. About 1 month later, computed tomography of abdomen showed ruptured HCC with debris containing liver abscess and hepaticoduodenal fistula. Esophagogastroduodenoscopy revealed hepaticoduodenal fistula and hepatic parenchyme covered with exudate. The patient was managed with supportive care, but the hepaticoduodenal fistula persisted.

Keywords: Hepaticoduodenal fistula, Hepatocellular carcinoma, Transarterial chemoembolization

References

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Fig. 1.

Huge hypervascular mass (12.3×9.5 cm) with central necrosis in the right lobe of the liver.

Fig. 2.

One month after the last TACE, abdominal computed tomography revealed a ruptured of hepatocellular carcinoma at the S7 of the liver with abscess formation and fistular tract to the duodenum. TACE, transarterial chemoembolization.

Fig. 3.

One month after the last TACE, esophagogastroduodenoscopy shows a fistula between the duodenal bulb and liver covered with exudate and parenchyme. TACE, transarterial chemoembolization.

Fig. 4.

One month after the last TACE, upper gastrointestinal series revealed extraluminal contrast leakage suggesting hepaticoduodenal fistula. TACE, transarterial chemoembolization.

Fig. 5.

One year after the last TACE, hepaticoduodenal fistula persisted in the esophgogastroduodenoscopy. TACE, transarterial chemoembolization.

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