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Case report
Gallbladder perforation following transarterial chemoembolisation; a rare but serious complication
  1. Eu Jin Lim1,2,
  2. Manfred Spanger2,3,
  3. John S Lubel1,2
  1. 1Department of Gastroenterology, Box Hill Hospital, Box Hill, Victoria, Australia
  2. 2Eastern Health Clinical School, Monash University, Box Hill, Australia
  3. 3Department of Radiology, Box Hill Hospital, Box Hill, Victoria, Australia
  1. Correspondence to Dr Eu Jin Lim, Department of Gastroenterology, Box Hill Hospital, Nelson Road, Box Hill, Victoria, 3128, Australia; ejlim{at}rocketmail.com

Abstract

Transarterial chemoembolisation (TACE) is the mainstay of treatment for large or multifocal hepatocellular carcinoma (HCC). However, this procedure is not without potential complications. We report the case of a 72-year-old man with cirrhosis with HCC treated by TACE using drug-eluting beads. He developed persistent fever and severe right upper quadrant pain post-procedure. CT abdomen revealed a large fluid collection closely abutting the gallbladder and tracking inferiorly along the right flank. This fluid collection originated from the gallbladder and contained locules of gas with a contrast-enhancing wall, consistent with an infected biloma. These imaging findings confirmed gallbladder perforation complicating TACE. The development of gallbladder perforation post-TACE from acute ischaemic cholecystitis producing gallbladder wall necrosis is exceedingly rare. The presence of gallbladder perforation must be recognised in patients with persisting symptoms and imaging evidence of a perihepatic fluid collection because specific treatment with intravenous antibiotics and percutaneous drainage of the biloma is necessary.

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