Acute necrotizing pancreatitis as a fatal complication�following DC Bead transcatheter arterial chemoembolization for hepatocellular carcinoma: A case report and review of the literature

Abstract

Transcatheter arterial chemoembolization (TACE) is one of the most effective palliative measures for patients with inoperable hepatocellular carcinoma (HCC). Acute pancreatitis is a rare but well-known complication following TACE. We herein present the case of a patient with HCC who developed fatal complications (acute necrotizing pancreatitis and upper gastrointestinal ulcers) after TACE with DC Beads. The patient was diagnosed with HCC in segments 4 and 8, measuring ~70 mm in greatest diameter, and he was treated by TACE. Hepatic arteriography revealed replacement of the origin of the right hepatic artery to the superior mesenteric artery, while the left hepatic artery originated from the celiac artery. After selection of the segmental arterial branches feeding the tumor, 2 ml of 100-300-µm-sized DC Beads loaded with 150 mg epirubicin were injected through the microcatheter. The patient complained of abdominal pain after the TACE procedure. Upper gastrointestinal endoscopy revealed longitudinal ulcers from the esophagus to the duodenum, and contrast-enhanced computed tomography revealed swelling of the pancreas and focal areas of low density in the pancreatic body, suggesting necrosis. The patient developed respiratory insufficiency, renal failure and sepsis, and finally succumbed to the complications 54 days after the procedure, despite general management of the acute pancreatitis. An autopsy revealed that the main cause of the patient's death was extensive pancreatic necrosis due to a gastroduodenal artery embolism after TACE with DC Beads. Therefore, it is crucial for treating physicians to be aware of this complication following TACE with DC Beads, particularly in patients with anatomical variations.

Endovascular therapy choices for different sites of delayed postoperative arterial hemorrhage after hepatobiliary pancreatic surgery: a retrospective study

“…When the hemorrhage site was the SMA branch or pancreatic artery, embolization was performed by coil only, with neither microspheres nor a gelatin sponge used for coil-assisted embolization. Several cases reported acute necrotizing pancreatitis after ectopic embolism during the transarterial chemoembolization (TACE) procedure (15)(16)(17), as a small particle embolizing agent, such as microspheres or a gelatin sponge, may give rise to ischemic pancreatitis. To prevent ischemic pancreatitis or bowel issues, we avoided using microspheres or a gelatin sponge in SMA branches or pancreatic arteries embolization.…”

Arsenic trioxide-loaded CalliSpheres: In vitro study of drug release and antitumor activity, and in vivo study of pharmacokinetics, treatment efficacy and safety in liver cancer

“…In recent years, several microsphere products have become commercially available in China, including CalliSphere beads (CBs) (Jiangsu Hengrui Medicine Co. Ltd.), DC beads (BTG) and HepaSphere (Merit Medical) ( 8 , 10 , 11 ). Among these, CBs are the first microsphere product independently developed by a local Chinese pharmaceutical company ( 12 ).…”

Новый Комплексный Способ Лечении Аррозивного Кровотечения При Остром Деструктивном Панкреатите На Этапе Гнойно- Септических Осложнений

“…Таким образом, замедляется, но не прекращается артериальный кровоток а мелких артериальных сосудах бассейна верхней брыжеечной артерии, системы селезеночной вены, сосудов собственно паренхимы ПЖ. Следует отметить, что эндоваскулярная эмболизация селезеночной артерии, даже на уровне отхождения ее от чревного ствола, вызывает достаточно редко серьезные осложнения [23].…”