BACKGROUNDLiver abscess is a serious complication following transcatheter arterial chemoembolization (TACE). Much attention has been paid to this condition as it may interfere with the treatment process and result in a poor prognosis of the patient. This study aimed to analyze the causes of liver abscess, a complication, after TACE for hepatic tumors and to summarize management approaches.

METHODSFrom June 2012 to June 2014, of 1480 consecutive patients who underwent TACE at our hospital, five patients developed liver abscess after TACE procedures for hepatic tumors. Of the five patients, each receiving conventional TACE, one underwent three sessions, two underwent two sessions, and the remaining two underwent one session of TACE. Demographic and clinical characteristics, together with management approaches and prognosis, were collected through a review of medical records.

RESULTSThese five patients were confirmed to have post-TACE liver abscess through clinical manifestations, laboratory, and imaging tests. After percutaneous drainage and anti-inflammatory treatments, the symptoms present in four patients with liver abscess significantly improved as evidenced by shrinkage or disappearance of the abscess cavity, and the patients recovered completely after sufficient drainage. The remaining patient experienced recurrent symptoms and abdominal abscess, achieved no significant improvement after treatment, and eventually died of severe infection and multiple organ failures.

CONCLUSIONSTACE must be implemented with extreme caution to avoid liver abscess. An effective management relies on an early diagnosis, prompt use of sufficient doses of appropriate antibiotics, and active implementation of abscess incision, drainage, and aspiration.

Adult ; Aged ; Carcinoma, Hepatocellular ; therapy ; Chemoembolization, Therapeutic ; adverse effects ; Humans ; Liver ; pathology ; Liver Abscess ; diagnosis ; etiology ; Liver Neoplasms ; therapy ; Male ; Middle Aged ; Retrospective Studies

BACKGROUND/AIMS: Practice guidelines recommend endoscopic band ligation (EBL) and endoscopic variceal obturation (EVO) for bleeding from esophageal varices and fundal varices, respectively. However, the optimal treatment for bleeding from cardiac varices along the lesser curvature of the stomach (GOV1) remains undefined. This retrospective study compared the efficacy between EBL and EVO for bleeding from GOV1. METHODS: Patients treated by EBL or EVO via cyanoacrylate injection for bleeding from GOV1 were enrolled. Patients diagnosed with hepatocellular carcinoma or treated with endoscopic injection sclerotherapy were excluded. RESULTS: The study included 91 patients treated for bleeding from GOV1. The mean age was 56.3±10.9 years (mean±SD), and 78 of them (85.7%) were men. Overall, 51 and 40 patients were treated with EBL and EVO, respectively. A trend for a higher hemostasis rate was noted in the EVO group (100%) than in the EBL group (82.6%, P=0.078). Varices rebled in 15 patients during follow-up. The rebleeding rate was significantly higher in the EBL group than in the EVO group (P=0.004). During follow-up, 13 patients died (11 in the EBL group and 2 in the EVO group); the survival rate was marginally significant between two groups (P=0.050). The rebleeding-free survival rate was significantly higher in the EVO group than in the EBL group (P=0.001). CONCLUSIONS: Compared to EBL, EVO offered significantly lower rebleeding rates, significantly higher rebleeding-free survival rates, and a trend for higher hemostasis and survival rates. EVO appears to be the better therapeutic option for bleeding from GOV1.
Adult ; Aged ; Carcinoma, Hepatocellular/complications ; Cyanoacrylates/*therapeutic use ; Disease-Free Survival ; Endoscopy, Gastrointestinal ; Female ; Gastrointestinal Hemorrhage/etiology/mortality/*therapy ; Humans ; Ligation ; Liver Cirrhosis/complications/diagnosis ; Liver Neoplasms/complications ; Male ; Middle Aged ; Proportional Hazards Models ; Recurrence ; Retrospective Studies ; Sclerotherapy ; Survival Rate ; Treatment Outcome

Aged ; Antineoplastic Agents ; adverse effects ; Carcinoma, Hepatocellular ; drug therapy ; Hand-Foot Syndrome ; diagnosis ; etiology ; Humans ; Liver Neoplasms ; drug therapy ; Male ; Neoplasms, Multiple Primary ; drug therapy ; Niacinamide ; adverse effects ; analogs & derivatives ; Phenylurea Compounds ; adverse effects

Portal vein thrombosis is an uncommon but an important cause of portal hypertension. The most common etiological factors of portal vein thrombosis are liver cirrhosis and malignancy. Albeit rare, portal vein thrombosis can also occur in the presence of local infection and inflammation such as pancreatitis or cholecystitis. A 52-year-old male was admitted because of general weakness and poor oral intake. He had an operation for colon cancer 18 months ago. However, colonic stent had to be inserted afterwards because stricture developed at anastomosis site. Computed tomography taken at admission revealed portal vein thrombosis and inflammation at colonic stent insertion site. Blood culture was positive for Escherichia coli. After antibiotic therapy, portal vein thrombosis resolved. Herein, we report a case of portal vein thrombosis with sepsis caused by inflammation at colonic stent insertion site which was successfully treated with antibiotics.
Anti-Bacterial Agents/therapeutic use ; Cholecystitis/etiology ; Colonic Neoplasms/pathology/therapy ; Escherichia coli/isolation & purification ; Escherichia coli Infections/drug therapy/etiology ; Humans ; Inflammation/*etiology ; Liver/diagnostic imaging ; Male ; Middle Aged ; Pancreatitis/etiology ; Portal Vein ; Sepsis/*diagnosis/drug therapy/microbiology ; Sigmoidoscopy ; Stents/*adverse effects ; Tomography, X-Ray Computed ; Venous Thrombosis/complications/*diagnosis

Primary colorectal choriocarcinoma is a rare neoplasm. Only 19 cases have been reported worldwide, most of which involved adenocarcinomas. The prognosis is usually poor, and the standard therapy for this tumor has not been established. A 61-year-old woman presented with constipation and lower abdominal discomfort. She was diagnosed with primary adenocarcinoma with focal choriocarcinomatous differentiation in the sigmoid colon and liver metastasis. Because the serum beta-human chorionic gonadotropin level was not significantly elevated, and because only focal choriocarcinomatous differentiation was diagnosed, we selected the chemotherapy regimen that is used for the treatment of metastatic colorectal adenocarcinoma. The patient survived for 13 months after the initial diagnosis. This is the first case in Korea to assess the suppressive effects of the standard chemotherapy for colorectal adenocarcinoma against coexisting colorectal choriocarcinoma and adenocarcinoma.
Adenocarcinoma/*diagnosis/drug therapy/pathology ; Antineoplastic Agents/administration & dosage ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; CA-19-9 Antigen/analysis ; Chorionic Gonadotropin, beta Subunit, Human/blood ; Colon, Sigmoid/pathology ; Colonic Neoplasms/*diagnosis/drug therapy/pathology ; Colonoscopy ; Constipation/etiology ; Female ; Fluorouracil/therapeutic use ; Humans ; Leucovorin/therapeutic use ; Liver Neoplasms/secondary ; Middle Aged ; Organoplatinum Compounds/therapeutic use ; Prognosis ; Tomography, X-Ray Computed

Invasion of the bile duct by hepatocellular carcinoma (HCC), which is called intrahepatic bile duct HCC, is rare and has a poor prognosis. Early diagnosis and surgical resection is important for treatment. A 58-year-old man who underwent hepatic resection for HCC 4 years ago and received transarterial chemoembolization (TACE) 2 years after the operation for recurred HCC presented with jaundice. CT scan revealed a tumor in the common bile duct without intrahepatic lesion. Therefore, ERCP was done to perform biopsy and biliary drainage. Histological examination was compatible with hepatocellular carcinoma. However, the tumor could not be visualized at angiography and thus, only transarterial chemoinfusion was performed without embolization. The tumor had disappeared on follow-up CT scan, and the patient has been disease free for 23 months without evidence of recurrence. Herein, we report a case of intrahepatic bile duct HCC which disappeared after ERCP.
Antibiotics, Antineoplastic/therapeutic use ; Bile Duct Neoplasms/diagnosis/pathology/secondary/*therapy ; Bile Ducts, Intrahepatic ; Carcinoma, Hepatocellular/*diagnosis/pathology ; Cholangiopancreatography, Endoscopic Retrograde ; Doxorubicin/therapeutic use ; Embolization, Therapeutic ; Ethiodized Oil/therapeutic use ; Humans ; Jaundice/etiology ; Liver Neoplasms/*diagnosis/pathology ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Stents ; Tomography, X-Ray Computed ; Treatment Outcome

Intraductal tumor invasion of hepatocellular carcinoma (HCC) is considered rare. Transarterial chemoembolization (TACE) is effective for tumor thrombus of HCC in the bile duct. However, a few cases of obstructive jaundice caused by migration of a tumor fragment after TACE have recently been reported. The aim of this study was to identify factors that affect tumor migration after TACE. At this writing, a review of the medical literature disclosed seven reported cases of biliary obstruction caused by migration of a necrotic tumor cast after TACE. We, herein, report on an additional case of acute obstructive cholangitis complicated by migration of a necrotic tumor cast after TACE for intrabile duct invasion of HCC, in a 71-year-old man. The tumor cast in the common bile duct was removed successfully using a basket during ERCP and was pathologically confirmed to be a completely necrotic fragment of HCC. The patient's symptoms showed dramatic improvement. In summary, physicians should be aware of acute obstructive cholangitis complicated by tumor migration in a patient undergoing TACE. We suggest that an intrabile duct invasion would be a major predisposing factor of tumor migration after TACE and drainage procedures such as ERCP or percutaneous transbiliary drainage could be effective treatment modalities in these patients.
Acute Disease ; Aged ; Antineoplastic Agents/administration & dosage ; Bile Ducts, Intrahepatic/pathology ; Carcinoma, Hepatocellular/*diagnosis/pathology/therapy ; Chemoembolization, Therapeutic/adverse effects ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis/*etiology ; Humans ; Jaundice, Obstructive/etiology ; Liver Neoplasms/*diagnosis/pathology/therapy ; Male ; Necrosis/pathology ; Sphincterotomy, Endoscopic ; Thrombosis/etiology ; Tomography, X-Ray Computed

No abstract available.
Adenocarcinoma/*complications/*diagnosis/pathology ; Aged, 80 and over ; Colonoscopy ; Ethanol/therapeutic use ; Female ; Gallbladder Neoplasms/*complications/*diagnosis/pathology ; Humans ; Intestinal Obstruction/*etiology ; Liver Neoplasms/complications/drug therapy/secondary ; Tomography, X-Ray Computed

Previous studies reported that oxaliplatin is associated with sinusoidal obstruction syndrome. However few reports on oxaliplatin induced liver fibrosis are found in the literature. Furthermore pathogenesis of liver fibrosis is not well known. We report a case of 45-yr-old Korean man in whom liver fibrosis with splenomegaly developed after 12 cycles of oxaliplatin based adjuvant chemotherapy for colon cancer (T4N2M0). Thorough history taking and serological examination revealed no evidence of chronic liver disease. Restaging CT scans demonstrated a good response to chemotherapy. Five month after chemotherapy, he underwent right hepatectomy due to isolated metastatic lesion. The liver parenchyma showed diffuse sinusoidal dilatation and centrilobular vein fibrosis with necrosis without steatosis. We could conclude that splenomegaly was due to perisinusoidal liver fibrosis and liver cell necrosis induced portal hypertension by oxaliplatin. In addition, to investigate the pathogenesis of liver fibrosis, immunohistochemical stains such as CD31 and alpha-smooth muscle actin (alpha-SMA) were conducted with control group. The immunohistochemical stains for CD31 and alpha-SMA were positive along the sinusoidal space in the patient, while negative in the control group. Chemotherapy with oxaliplatin induces liver fibrosis which should be kept in mind as a serious complication.
Actins/metabolism ; Antigens, CD31/metabolism ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Camptothecin/*analogs & derivatives/therapeutic use ; Chemotherapy, Adjuvant ; Colonic Neoplasms/*drug therapy ; Fluorouracil/therapeutic use ; Humans ; Hypertension, Portal/etiology ; Immunohistochemistry ; Leucovorin/therapeutic use ; Liver Cirrhosis/*diagnosis/etiology/pathology ; Liver Neoplasms/secondary/surgery ; Male ; Middle Aged ; Organoplatinum Compounds/*administration & dosage/adverse effects/therapeutic use ; Splenomegaly/*diagnosis/etiology ; Thrombocytopenia/etiology ; Tomography, X-Ray Computed

Because of its safety and treatment effectiveness, the popularity of radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC) has gradually increased. However, some serious complications of RFA such as hepatic infarction, bowel perforation, and tumor seeding have been reported. Recently, we experienced a case of diaphragmatic hernia after RFA for HCC. A 61-year-old man with alcoholic cirrhosis was diagnosed with a 1.0 cm sized HCC in segment (S) 5 and a 1.3 cm sized HCC in S 8 of the liver. He was treated by transarterial chemoembolization and RFA. After RFA, an abdominal CT revealed a diaphragmatic defect with herniating mesentery. Twenty-two months after the RFA, the chest CT showed the diaphragmatic defect with herniating colon and mesentery. Because he had no symptoms, and surgical repair for the diaphragmatic hernia would be a high risk operation for him, we decided to treat the patient conservatively. For its great rarity, we report this case with a review of the literature.
Carcinoma, Hepatocellular/*diagnosis/*radiotherapy/therapy ; Catheter Ablation/*adverse effects ; Chemoembolization, Therapeutic ; Hernia, Diaphragmatic/*etiology/surgery ; Humans ; Liver Cirrhosis, Alcoholic/complications/*diagnosis ; Liver Neoplasms/*diagnosis/*radiotherapy/therapy ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Tomography, X-Ray Computed