Giant Hepatic Biloma Following Transcatheter Oily Chemoembolization in a Patient with Hepatic Metastases from Malignant Pheochromocytoma.

Abstract

A 48-year-old womandeveloped hepatic metastases from malignant pheochromocytoma resected 8 years previously. Angiography revealed multiple tumor stains in the liver. Transcatheter oily chemoembolizationusing styrenomaleic acid neocarzinostatin and iodized oil was performed.The patient complained of severe right upper quadrant pain immediately following the transcatheter oily chemoembolization. Necrotizing cholecystitis developed on the 4th day post-transcatheter oily chemoembolization, hepatic infarction on the 12th day, and a biloma on the 19th day. Despite the administration of antibiotics and percutaneous transhepatic drainage, neither the volume of drainage nor the size of the biloma decreased. Biliary reconstruction was performed using a metallic stent, which decreased the size of the biloma.

Hepatic arterial infusion of floxuridine and dexamethasone plus high-dose Mitomycin C for patients with unresectable hepatic metastases from colorectal carcinoma

“…The dose-limiting toxicity of HAI FUDR is fibrotic narrowing of the bile ducts, which is similar to primary biliary sclerosis. The use of regional Dex with FUDR has reduced hepatic toxicity, and in the last two studies at MSKCC, the biliary sclerosis rate was 3% or less [10,17]. In the present study, even with the use of Dex, biliary sclerosis was seen in 9.5% of patients.…”

“…These fluid-filled sacs were classified on CT as bilomas because their Hounsfield units suggested this fluid was not water or blood but rather pockets of bile. Bilomas have been reported after transcatheter chemoembolization and thought to be caused by hepatic infarction or bile duct necrosis [17][18][19]. Biloma formation has been seen more often in metastatic liver tumors than in hepatocellular cancer after embolization [17].…”

“…Bilomas have been reported after transcatheter chemoembolization and thought to be caused by hepatic infarction or bile duct necrosis [17][18][19]. Biloma formation has been seen more often in metastatic liver tumors than in hepatocellular cancer after embolization [17]. Bile ducts as well as hepatic tumors derive their blood supply from the hepatic artery, and therefore are being exposed to a higher concentration of the drug.…”

A novel technique for the internal drainage of extrahepatic biloma complicating transarterial embolization of hepatocellular carcinoma

“…[4][5][6] Biloma is an infrequent complication of both procedures and is often related to biliary tract injuries caused by local ischemia. 4,7,8 Retrograde contamination with enteric bacterial fl ora may result in the formation of a liver abscess and threaten the prognosis after therapy. 4,9,10 While a biloma remains small and without contamination, it can be suffi ciently managed by conservative treatment.…”

Transcatheter Arterial Embolization for the Treatment of Liver Metastases in a Patient with Malignant Pheochromocytoma

“…More recently, transcatheter arterial embolization (TAE) has been successfully performed for the treatment of hepatocellular carcinoma (HCC). Only very limited cases of TAE for the metastatic lesions of malignant pheochromocytoma, however, have been reported in the literature [6][7][8][9][10][11][12][13].…”