Bile duct necrosis because of transcatheter hepatic arterial embolization (THAE) in two patients with hepatocellular carcinoma is reported. Preoperative THAE was performed on 29 patients, and bile duct necrosis was experienced by two of the 29 (7%). In these two patients, gelatin (Gelfoam) powder was used as the embolus. Among the 24 whose embolus was clear, four were embolized with gelatin powder. Therefore, incidence of bile duct necrosis after THAE with gelatin powder was 50%. Because of the hazards of severe complications such as bile duct necrosis, we conclude that gelatin powder should not be used except for the THAE of no more than one segment of the liver.
A 41-year-old woman with cirrhosis of the liver was admitted to our hospital because of a severe melena. Blood pool scanning with labelled red blood cells showed a high concentration in the right upper quadrant of the abdomen. Endoscopy of the second portion of the duodenum revealed fresh blood on the first examination and varices with overlying erosion were evident in the second study. Co-existent esophageal varices were present but were apparently not associated with the bleeding. Because of the continuous hypotension even with blood replacement, ligation and sclerotherapy were performed. To evaluate the efficacy of the procedures, intraoperative two-dimensional Doppler echography was used and the transducer was applied directly to the viscera. Blood flow was visualized in the serosal and submucosal varices. After ligation and sclerosing of the veins, the blood flow velocity signals disappeared. This woman died of multiple organ failure on the ninth postoperative day.
Percutaneous transhepatic biliary drainage (PTBD) guided by color Doppler echography was performed on nine patients. By color Doppler echography, the segmental and subsegmental branches of both the portal vein and the hepatic artery could be identified and discriminated from the bile ducts because of their color flow mapping. We could select the safe pathway of needle advance, which did not injure the vessels. Thus, complication of bleeding did not occur in any of the patients. Color Doppler echography seems a very useful and safe method for the guidance of PTBD.
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