Spontaneous right hepatic artery branch gallbladder fistula revealed by haemobilia and upper cataclysmic gastrointestinal bleeding

Chemoembolization with irinotecan-loaded microspheres has proven effective in the treatment of unresectable liver metastases in the course of colorectal cancer (CRC). Most researchers recommend slowly administering the embolizate at the level of the lobar arteries, without obtaining visible stasis. However, there are reports of a relationship between postoperative embolizate retention in metastatic lesions and the response to treatment. To retain residual embolizate throughout the entire neoplastic lesion requires a temporary flow stop (stasis) within all supply vessels, which may cause temporary stasis in subsegmental or even segmental vessels. Objective: To assess the risk of complications and post-embolization syndrome severity following chemoembolization of CRC metastatic liver lesions with microspheres loaded with Irinotecan, with regard to hepatic-artery branch level of temporary stasis. Patients and methods: The study included 52 patients (29 female, 23 male) with liver metastases from CRC, who underwent 202 chemoembolization treatments (mean: 3.88 per patient) with microspheres loaded with 100 mg irinotecan. Postembolization syndrome (PES) severity and complication occurrence were assessed with regard to the hepatic-artery branch level of temporary stasis. Adverse events were assessed according to Cancer Therapy Evaluation Program Common Terminology Criteria for Adverse Events. Results: Median survival from the start of chemoembolization was 13 months. From 202 chemoembolization sessions, 15 (7.4%) significant complications were found. The study found a significant relationship between the branch level of temporary stasis and the presence of complications (p < 0.001), with the highest number of complications observed with temporary stasis in segmental vessels. PES was diagnosed after 103 (51%) chemoembolization treatments. A significant association was found between PES severity and the branch level of temporary stasis (p < 0.001). Conclusions: The branch level of temporary stasis affected the severity of post-embolization syndrome. A significant association was found between the branch level of temporary stasis obtained in chemoembolization procedures and the presence of complications. The apparent lack of change in numbers of complications when stasis was applied at tumor supply vessels or subsegmental arteries may indicate the safe use of temporary stasis in some cases where colorectal cancer metastases are treated. Further research is needed to determine the most effective chemoembolization technique.

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False aneurysm of a hepatic artery branch and a recurrent subphrenic abscess

Surgical Endoscopy ◽

10.1007/bf00188363 ◽

1996 ◽

Vol 10 (2) ◽

pp. 161-163 ◽

Cited By ~ 12

Author(s):

R. J. Porte ◽

E. G. Coerkamp ◽

R. K. J. Koumans

Keyword(s):

Hepatic Artery ◽

False Aneurysm ◽

Subphrenic Abscess ◽

Hepatic Artery Branch ◽

Artery Branch

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Massive upper gastrointestinal bleeding due to right hepatic artery pseudoaneurysm secondary to cholecystitis

Open Medicine ◽

10.2478/s11536-013-0204-3 ◽

2013 ◽

Vol 8 (5) ◽

pp. 665-668

Author(s):

K. Habib ◽

G. Williams

Keyword(s):

Gastrointestinal Bleeding ◽

Hepatic Artery ◽

Upper Gastrointestinal Bleeding ◽

Japanese Literature ◽

Biliary Tree ◽

Artery Pseudoaneurysm ◽

Right Hepatic Artery ◽

Hepatic Artery Pseudoaneurysm ◽

Upper Gastrointestinal Bleed ◽

Upper Gastrointestinal

AbstractA literature trawl reveals a substantial number of reports on true visceral aneurysms, including the hepatic artery, but only a handful of cases of visceral pseudoaneurysms. The ones in relation to the biliary tree are associated with previous gall bladder surgery and can result in significant gastrointestinal bleeding. There are more than 10 reported cases of cystic artery pseudoaneurysms but a thorough search revealed only two cases in English (1,2) and perhaps one in Japanese literature of right hepatic artery pseudoaneurysm secondary to cholecystitis presenting as massive upper gastrointestinal bleed. We present a probable fourth case in a 52 year old woman with classical clinical/biochemical picture, typical radiological appearance and who underwent successful interventional radiological treatment of this condition.

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Portal Vein Tract Embolization After Percutaneous Transhepatic Biliary Interventions

10.1093/med/9780199986071.003.0087 ◽

2018 ◽

Author(s):

Kazim Narsinh ◽

Steven C. Rose ◽

Thomas Kinney

Keyword(s):

Portal Vein ◽

Hepatic Artery ◽

Arterial Embolization ◽

Bleeding Complications ◽

Hepatic Arteriography ◽

Portal Vein Branch ◽

Vein Access ◽

Suitable Target ◽

Hepatic Artery Branch ◽

Artery Branch

Bleeding complications during percutaneous biliary intervention result from injury to the hepatic artery, hepatic vein, or portal vein. If bleeding originating from a hepatic artery branch is suspected, hepatic arteriography should be performed with and without the drainage catheter in place over a wire, and subselective embolization can be performed if a suitable target is identified. If a bleeding hepatic artery branch is not identified, bleeding from a portal vein branch is suspected. Treatment of portal vein injuries is challenging in this situation because obtaining direct percutaneous portal vein access is ill-advised. Although injuries to the hepatic artery or vein can often be treated by tract tamponade or arterial embolization, iatrogenic communication between the portal vein and biliary system can be difficult to treat effectively. This chapter presents a method to identify portal vein-to-biliary tract communications via cholangiography, with subsequent embolization via the transhepatic tract.

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