Emphysematous cholecystitis as a complication of hepatic arterial embolization

Abstract

We describe a case of emphysematous cholecystitis that developed 2 weeks after hepatic arterial embolization. Angiographers should be alert to the possibility of this complication developing under conditions when the cystic artery is not visualized on the post embolization arteriogram while present on the diagnostic study before embolization.

Effervescent gallbladder: Sonographic findings in emphysematous cholecystitis

“…2,3,5 The pathophysiology of emphysematous cholecystitis involves ischemia of the gallbladder followed by bacterial invasion. 1,9,10 This is supported by reports of emphysematous cholecystitis developing from an embolism of the cystic artery after transhepatic arterial embolization for hepatoma, 11,12 from an atheromatous embolism of the cystic arterial branch after abdominal aortography, 13 and from hypoperfusion of the gallbladder during cardiopulmonary resuscitation. 9 Furthermore, May and Strong 14 noted narrowed and occluded blood vessels in the gallbladder walls of 3 patients with emphysematous cholecystitis.…”

Interventional Oncology–Avoiding Common Pitfalls to Reduce Toxicity in Hepatic Radioembolization

“…The cystic artery remains a vessel of controversy, and must be considered in all forms of embolic therapy. Fortunately, involvement of this vessel leads to relatively few sequelae, with the vast majority of severe presentations published as case reports [11,12]. Collectively, the incidence of radiation induced cholecystitis is rare, with less than 1% requiring surgical intervention however described within the literature [13][14][15].…”