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Tarantino L, Nasto A, Di Sario P, Sellitto S, Nasto RA, Pellegrini L. Salvage radiofrequency ablation for microwave ablation treated hepatocellular carcinoma complicated by gas gangrene: case report. J Ultrasound 2024:10.1007/s40477-024-00928-2. [PMID: 38940887 DOI: 10.1007/s40477-024-00928-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 05/22/2024] [Indexed: 06/29/2024] Open
Abstract
AIM Gas gangrene (GG) is a rare severe infection with a very high mortality rate mainly caused by Clostridium species. It develops suddenly, often as a complication of abdominal surgery or liver transplantation. We report a case of GG of the liver occurred after percutaneous microwave (MW) ablation of an hepatocellular carcinoma (HCC) successfully treated with percutaneous Radiofrequency ablation (RFA). CASE PRESENTATION A 76-year-old female patient was treated with MW ablation for a large HCC in the VIII segment; 2 days later she developed fever, weakness, abdominal swelling and was hospitalized with diagnosis of anaerobic liver abscess. Despite antibiotic therapy, the patient conditions worsened, and she was moved to the intensive care unit (ICU). Percutaneous drainage was attempted, but was unsuccessful. The surgeon and the anesthesiologist excluded any indication of surgical resection. We performed RFA of the GG by 3 cool-tip needles into the infected area. The procedure was well tolerated by the patient, who left the hospital for follow-up. CONCLUSION Percutaneous RFA could be a valuable therapy of focal GG of the liver in patients refractory to antibiotics and when surgery and OLT are not feasible. A fast and early indication is needed in case of rapid worsening of the patient's conditions.
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Affiliation(s)
- Luciano Tarantino
- U.O. Chirurgia, Unità di Ecografia Interventistica, ASL Salerno, Ospedale L. Curto, Polla, Italy.
| | - Aurelio Nasto
- U.O. Chirurgia, ASL Salerno, Ospedale L. Curto, Polla, Italy
| | - Pino Di Sario
- U.O. Chirurgia, Unità di Ecografia Interventistica, ASL Salerno, Ospedale L. Curto, Polla, Italy
| | - Simone Sellitto
- Istituto di Radiologia - Università degli Studi di Udine, Udine, Italy
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Cocca S, Carloni L, Marocchi M, Grande G, Bianchini M, Colecchia A, Conigliaro R, Bertani H. Post-trans-arterial chemoembolization hepatic necrosis and biliary stenosis: Clinical charateristics and endoscopic approach. World J Clin Cases 2023; 11:8434-8439. [PMID: 38188216 PMCID: PMC10768501 DOI: 10.12998/wjcc.v11.i36.8434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 12/22/2023] Open
Abstract
Liver cancer is the fifth most common tumor and the second highest death-related cancer in the world. Hepatocarcinoma (HCC) represents 90% of liver cancers. According to the Barcelona Clinic Liver Cancer group, different treatment options could be offered to patients in consideration of tumor burden, liver function, patient performance status and biochemical marker serum concentration such as alpha-fetoprotein. Trans-arterial chemoembolization (TACE) is the treatment of choice in patients with diagnosis of unresectable HCC not eligible for liver transplantation, and preserved arterial supply. TACE is known to be safe and its complications are generally mild such as post-TACE syndrome, a self-resolving adverse event that occurs in about 90% of patients after the procedure. However, albeit rarely, more severe adverse events such as biloma, sepsis, hepatic failure, chemoagents induced toxicities, and post-TACE liver necrosis can occur. A prompt diagnosis of these clinical conditions is fundamental to prevent further complications. As a result, biliary stenosis could be a rare post-TACE necrosis complication and can be difficult to manage. Complications from untreated biliary strictures include recurring infections, jaundice, chronic cholestasis, and secondary biliary cirrhosis.
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Affiliation(s)
- Silvia Cocca
- Gastroenterology and Endoscopy Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena 41121, Italy
| | - Lorenzo Carloni
- Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 00100, Italy
| | - Margherita Marocchi
- Gastroenterology and Endoscopy Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena 41121, Italy
| | - Giuseppe Grande
- Gastroenterology and Endoscopy Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena 41121, Italy
| | - Marcello Bianchini
- Department of Internal Medicine, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena 41121, Italy
| | - Antonio Colecchia
- Department of Internal Medicine, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena 41121, Italy
| | - Rita Conigliaro
- Gastroenterology and Endoscopy Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena 41121, Italy
| | - Helga Bertani
- Gastroenterology and Endoscopy Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena 41121, Italy
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Wang Y, Chang Z, Zheng J, Liu Z, Zhang J. The impact of liver abscess formation on prognosis of patients with malignant liver tumors after transarterial chemoembolization. Front Oncol 2023; 13:1256012. [PMID: 38023156 PMCID: PMC10661366 DOI: 10.3389/fonc.2023.1256012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Liver abscess is a rare and serious complication after transarterial chemoembolization (TACE) for liver cancer; however, its impact on the prognosis is unclear. This retrospective study examined the outcomes of patients with liver abscess formation following TACE for malignant liver tumors to elucidate the impact of liver abscess formation on the prognosis of these patients. Methods From January 2017 to January 2022, 1,387 patients with malignant tumors underwent 3,341 sessions of TACE at our hospital. Clinical characteristics of patients at baseline and follow-up were examined, including treatment and outcome of liver abscess, tumor response to the TACE leading to liver abscess, and overall survival time. Results Of 1,387 patients, 15 (1.1%) patients with liver abscess complications after TACE resulted in a total of 16 (0.5%) cases of liver abscess after 3,341 TACE sessions (including one patient with two events). After antibiotic or percutaneous catheter drainage (PCD) treatment, all the infections associated with liver abscesses were controlled. In the PCD group, eight patients died before drainage tube removal, one retained the drainage tube until the end of follow-up, and five underwent drainage tube removal; the mean drainage tube removal time was 149.17 ± 134.19 days. The efficacy of TACE leading to liver abscess was evaluated as partial response (18.75%), stable disease (37.5%), and progressive disease (43.75%). Eleven patients died during the follow-up period owing to causes unrelated to infections caused by liver abscesses. The survival rates at 3 months, 6 months, 1 year, and 5 years were 86.7%, 50.9%, 25.5%, and 17%, respectively. Conclusion Patients with liver abscess formation following TACE for malignant liver tumors experienced prolonged drainage tube removal time after PCD; while this condition did not directly cause death, it indirectly contributed to a poor prognosis in these patients.
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Affiliation(s)
| | | | | | | | - Jun Zhang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
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Liu YM, Ren YQ, Song SL, Zheng CS. Pyogenic liver abscess in non-liver cancer patients and liver cancer patients treated with TACE: Etiological characteristics, treatment, and outcome analysis. Kaohsiung J Med Sci 2023; 39:87-94. [PMID: 36354204 DOI: 10.1002/kjm2.12613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 11/11/2022] Open
Abstract
Clinical, laboratory, and microbiological features, clinical outcomes, and pyogenic liver abscess (PLA) prognosis evaluation in non-liver cancer (Non-LC) and liver cancer patients treated with transarterial chemoembolization (TACE, LC-TACE). Clinical data of 48 consecutive PLA patients from January 2016 to December 2020 were retrospectively analyzed. Mortality between two PLA patient groups were compared, and mortality risk factors were evaluated. A total of 48 PLA patients (31 males and 17 females) from January 2016 to December 2020 met the study's inclusion criteria. There were 32 and 16 patients in the Non-LC and LC-TACE groups, respectively. Positive pus culture rate in the Non-LC group was 87.5% and positive pus culture rate in LC-TACE group was 81.3%. In the Non-LC group, 28 patients improved after treatment, 1 patient did not improve, and 3 patients died during hospitalization, with a 9.4% mortality rate. In the LC-TACE group, nine patients improved after treatment, three patients did not improve, and four patients died during hospitalization, with a 25% mortality rate. The Non-LC group cure time was 37.4 ± 23.1 days, while the LC-TACE group was 91.5 ± 49.7 days. PLA of the Non-LC group and the LC-TACE group were different in terms of pathogenic bacteria and cure time, and so on. A more comprehensive treatment should be considered for PLA after TACE.
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Affiliation(s)
- Yi-Ming Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Provinve Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yan-Qiao Ren
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Provinve Key Laboratory of Molecular Imaging, Wuhan, China
| | - Song-Lin Song
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Provinve Key Laboratory of Molecular Imaging, Wuhan, China
| | - Chuan-Sheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Provinve Key Laboratory of Molecular Imaging, Wuhan, China
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Xu L, Wang Y, Li W. A case report of fatal hepatic portal venous gas after transcatheter arterial chemoembolization in a patient with hepatocellular carcinoma. Transl Cancer Res 2022; 10:5437-5442. [PMID: 35116389 PMCID: PMC8798820 DOI: 10.21037/tcr-21-1721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/04/2021] [Indexed: 11/21/2022]
Abstract
Hepatic portal venous gas (HPVG) refers to the imaging signs formed by the abnormal accumulation of abnormal gas in the portal veins and the branches of the inner veins of the liver due to various reasons, and is usually associated with poor prognosis. HPVG is mostly caused by abdominal diseases. Herein, we reported a patient with hepatocellular carcinoma developed HPVG following transcatheter arterial chemoembolization (TACE). This patient was identified as Barcelona Clinic Liver Cancer (BCLC) stage B, and treated by five times of TACE. Gelfoam sponge was used as embolic agent in the first and last TACE treatment. After the first TACE, pneumonia occurred in the right lung, and pneumorachis with iodine oil deposition occurred in the tumor lesion in the right lobe of the liver, which was considered as hepatic abscess. After three more TACE, enhanced MRI showed significant necrosis and reduction of the lesions. After the fifth TACE, the enhancing computed tomography (CT) showed a large amount of gas in the lesions and in the portal veins, which was considered as HPVG. Although after active treatment, the patient died soon. To our knowledge, this is the first case report of a patient with hepatocellular carcinoma developed HPVG following TACE with gelfoam sponge as embolic agent.
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Affiliation(s)
- Lichao Xu
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ying Wang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Wentao Li
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
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Díaz Alcázar MDM, Martín-Lagos Maldonado A, Ruiz Escolano E. Unusual complication after chemoembolisation of hepatocellular carcinoma over liver cirrhosis: Liver abscess and pylephlebitis. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 44:382-383. [PMID: 32718837 DOI: 10.1016/j.gastrohep.2020.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 11/25/2022]
Affiliation(s)
- María Del Mar Díaz Alcázar
- Unidad de Gestión Clínica del Aparato Digestivo, Hospital Universitario Clínico San Cecilio, Granada, España.
| | | | - Elena Ruiz Escolano
- Unidad de Gestión Clínica del Aparato Digestivo, Hospital Universitario Clínico San Cecilio, Granada, España
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Mizandari M, Azrumelashvili T, Toria N, Nanava N, Pantsulaia I, Kikodze N, Janikashvili N, Chikovani T. Cured giant hepatocellular carcinoma after transarterial embolization complicated with liver abscess formation. Radiol Case Rep 2020; 15:1485-1492. [PMID: 32670446 PMCID: PMC7338999 DOI: 10.1016/j.radcr.2020.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 02/08/2023] Open
Abstract
Many patients with hepatocellular carcinoma cannot be treated surgically because of the advanced stage of the tumor and/or coexisting cirrhosis. Transcatheter arterial embolization (TAE) represents an alternative therapeutic approach for some of these patients. However, it is not a curative measure, and an additional therapy is required to eradicate the residual disease. In this communication, we report a case of 55-year-old man with giant hepatocellular carcinoma located in the right lobe of the liver that was successfully treated with TAE. TAE completely devascularized the tumor in one session. Despite of postembolization antibiotic therapy, complete tumor necrosis led to abscess formation. After 57 days of abscess drainage, necrotic tumor tissue was completely evacuated from the drained cavity; no viable tumor tissue was identified by computed tomography/magnetic resonance imaging scan on a 5 year follow-up. TAE procedure can be suggested as a modulator of antitumor immune response, by exposing tumor antigens after necrosis leading to inflammation. In addition to necrosis caused by TAE, an antimicrobial acute inflammatory reaction in the treated area led to the complete destruction of the giant tumor.
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Affiliation(s)
- Malkhaz Mizandari
- Department of Diagnostic & Interventional Radiology of New Hospitals LTD, Tbilisi, Georgia.,Department of Radiology, Tbilisi state Medical University, Tbilisi, Georgia
| | | | - Nino Toria
- Department of Immunology, Tbilisi state Medical University, Street 33, Vazha-Pshavela Ave, Tbilisi, 0689, Georgia
| | - Nino Nanava
- Department of Immunology, Tbilisi state Medical University, Street 33, Vazha-Pshavela Ave, Tbilisi, 0689, Georgia
| | - Ia Pantsulaia
- Department of Immunology, Tbilisi state Medical University, Street 33, Vazha-Pshavela Ave, Tbilisi, 0689, Georgia
| | - Nino Kikodze
- Department of Immunology, Tbilisi state Medical University, Street 33, Vazha-Pshavela Ave, Tbilisi, 0689, Georgia
| | - Nona Janikashvili
- Department of Immunology, Tbilisi state Medical University, Street 33, Vazha-Pshavela Ave, Tbilisi, 0689, Georgia
| | - Tinatin Chikovani
- Department of Immunology, Tbilisi state Medical University, Street 33, Vazha-Pshavela Ave, Tbilisi, 0689, Georgia
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