Abstract
We herein describe a case of a gas-forming pyogenic liver abscess following transcatheter hepatic arterial embolization (THAE) for an iatrogenic intrahepatic pseudoaneurysm in a 74-year-old woman. Hemobilia developed 19 days after percutaneous transhepatic cholangio-drainage was performed for the purpose of percutaneous cholangioscopic lithotripsy for the treatment of post-gastrectomy choledo-cholithiasis. Celiac arteriography disclosed a saccular aneurysm in the right hepatic artery. The pseudoaneurysm was successfully occluded by THAE with gelatin powder and a stainless steel coil of the Gianturco type. Ten days after successful THAE, abdominal computed tomography revealed a gas-containing cavity, which suggested the presence of a gas-forming abscess, in the posterior hepatic segment, and percutaneous transhepatic abscess drainage was performed. Thus, impaired hepatic perfusion following effective THAE and coexisting cholangitis may play an important role in the development of a gas-forming pyogenic liver abscess.
Similar content being viewed by others
References
Goldblatt M, Rad FF, Goldin AR, Shaff MI (1977) Percutaneous embolization for the management of hepatic artery aneurysms. Gastroenterology 73:1142–1146
Kadir S, Athanasoulis CA, Ring EJ, Greenfield A (1980) Transcatheter embolization of intrahepatic arterial aneurysms. Radiology 134:335–339
Sarr MG, Kaufman SL, Zuidema GD, Cameron JL (1983) Management of hemobilia asociated with transhepatic internal biliary drainage catheters. Surgery 95:603–607
Baker KS, Tisnado J, Cho SR, Beachley MC (1987) Splanchnic artery aneurysms and pseudoaneurysms: Transcatheter embolization. Radiology 163:135–139
Lygidakis NJ, Okazaki M, Damtsios G (1991) Iatrogenic hemobilia: How to approach it. Hepatogastroenterology 38:454–457
Salam TA, Lumsden AB, Martin LG, Smith RB (1992) Non-operative management of visceral aneurysms and pseudoaneurysms. Am J Surg 164:215–219
Ashizawa, K, Matsunaga N, Asoh N, Morikawa M, Isomoto I, Ajimu A, Fukuda T, Irie J, Hayashi K (1991) Bile lake: Complications of transcatheter hepatic arterial infusion and embolization (TAI, TAE). (in Japanese with English abstract) Nihon Igaku Houshasen Gakkai Zasshi (Jpn Act Radiol) 51:121–126
Doppman JL, Dunnick NR, Girton M, Fauci AS, Popovsky MA (1979) Bile duct cysts secondary to liver infarcts: Report of a case and experimental production by small vessel hepatic artery occlusion. Radiology 130:1–5
Makuuchi M, Sugihara M, Mori T, Kobayashi J, Yamazaki S, Moriyama N, Takayasu K, Hirohashi S (1985) Bile duct necrosis: Complication of transcatheter hepatic arterial embolization. Radiology 156:331–334
Trojanowski JQ, Harrist TJ, Athanasoulis CA, Greenfield AJ (1980) Hepatic and splenic infarctions: Complications of therapeutic transcatheter embolization. Am J Surg 139:272–277
Koizumi J, Kodera K, Kaneda S (1990) Liver abscess as a complication of TAE — Risk factors and Prevention (in Japanese with English abstract) Nippon Igaku Houshasen Gakkai Zasshi (Jpn Act Radiol) 50:592–598
Hanazaki K, Kajikawa S, Horigome N, Shiohara E, Haba Y, Kuroda T, Iida F (1993) Gas-forming liver abscess after transcatheter arterial embolization for hepatocellular carcinoma: Report of a case. Surg Today 23:747–749
Jochimsen PR, Zike WL, Shirazi SS, Pearlman NW (1978) Iatrogenic liver abscess. A complication of hepatic artery ligation for tumor. Arch Surg 113:141–144
D'Orci CJ, Ensminger W, Smith EH, Lew M (1979) Gas-forming intrahepatic abscess: A possible complication of arterial infusion chemotherapy. Gastrointest Radiol 4:157–161
Doppman JL, Girton M, Vermess M (1982) The risk of hepatic artery embolization in the presence of obstructive jaundice. Radiology 143:37–43
Morioka T, Makino H, Takezakura E, Kayahara M, Takeyama S, Arakawa F, Arai K, Saito K (1991) Two cases of gas-containing liver abscess — Review of Japanese literature. (in Japanese) Nihon Shoukakibyou Gakkai Zasshi (Jpn J Gastroenterol) 88:2691–2696
Yang CC, Chen CY, Lin XZ, Chang TT, Shin JS, Lin CY (1993) Pyogenic liver abscess in Taiwan: Emphasis on gasforming liver abscess in diabetics. Am J Gastroenterol 88:1911–1915
Huang JJ, Chen KW, Ruaan MK (1991) Mixed acid fermentation of glucose as a mechanism of emphysematous urinary tract infection. J Urol 146:148–151
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Satoh, H., Takeda, T., Takashima, M. et al. Gas-forming liver abscess following transcatheter hepatic arterial embolization for an iatrogenic intrahepatic pseudoaneurysm: Report of a case. Surg Today 25, 361–364 (1995). https://doi.org/10.1007/BF00311261
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00311261