Liver abscess complicating transcatheter arterial embolization

Ong, Guan-Yeow; Changchien, Chi‐Sin; Lee, Chuan–Mo; Wang, Jing‐Houng; Tung, Hung‐Da; Chuah, Seng-Kee; Chiu, King-Wah; Chiou, Shue-Shian; Cheng, Yu‐Fan; Lu, Sheng‐Nan

doi:10.1097/01.meg.0000108361.41221.8c

Cited by 36 publications

(14 citation statements)

References 24 publications

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“…Infectious complications are rare after TACE because of antiseptic measures 6 and the incidence of liver abscess is described in literature as 0.26%. 10 However, the incidence of post TACE liver abscess is higher among patients with bilio-enteric anastomoses, 11 which was the case of this patient.…”

Section: Discussionmentioning

confidence: 70%

Risk Factors for the Development of Postembolization Syndrome after Transarterial Chemoembolization for Hepatocellular Carcinoma Treatment

et al. 2018

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RESUMOIntrodução: A quimioembolização hepática é uma técnica amplamente usada para o tratamento do carcinoma hepatocelular. A principal complicação deste procedimento é a síndrome pós-quimioembolização. O principal objetivo deste estudo foi determinar fatores de risco para síndrome pós-quimioembolização. Material e Métodos: Análise retrospetiva unicêntrica de 563 procedimentos de quimioembolização hepática efetuados entre 1/1/2014-31/12/2015. A quimioembolização hepática foi efetuada com ½ -2 ampolas de microesferas 100 -300 μm carregadas com doxorrubicina. Os pacientes que desenvolveram síndrome pós-quimioembolização foram identificados pelo prolongamento do internamento por dor, febre, náuseas e/ou vómitos. Um grupo controlo com os pacientes que não desenvolveram síndrome pós-quimioembolização foi criado de forma randomizada (três controlos para um caso). Foi realizada análise descritiva e regressão logística multivariada. Resultados: A prevalência global de síndrome pós-quimioembolização foi 6,2%. Quimioembolização hepática com dose de doxorrubicina superior a 75 mg (mais de uma ampola), o tamanho do nódulo maior e o género feminino demonstraram relação estatisticamente significativa com o desenvolvimento de síndrome pós-quimioembolização (p = 0,030, p = 0,046 e p = 0,037, respetivamente , 2015. Hepatic transarterial chemoembolization was performed with ½ -2 vials of 100 -300 μm microspheres loaded with doxorubicin. Patients who experienced postembolization syndrome were identified based on prolongation of hospitalization due to pain, fever, nausea and/or vomiting. A control group with the patients who did not have postembolization syndrome was randomly created (three controls for one case). Descriptive analysis and multivariate logistic regression were performed. Results: The overall prevalence of postembolization syndrome was 6.2%. Hepatic transarterial chemoembolization with doxorubicin dosage above 75 mg (more than one vial), the size of the largest nodule and female gender had statistically significant relation with development of postembolization syndrome (p = 0.030, p = 0.046 and p = 0.037, respectively). Discussion: Doxorrubicin dosage above 75 mg is associated with a higher risk of postembolization syndrome. This result can be helpful for decision-making in clinical practice, whenever it is possible to avoid a higher dose without compromising the efficacy of the treatment. The size of the largest nodule and female gender also constitute risk factors for postembolization syndrome. The other variables studied were not related to the development of postembolization syndrome. Conclusion:The dose of doxorrubicin, the size of the largest nodule treated and female gender are potential risk factors for the development of postembolization syndrome after hepatic transarterial chemoembolization for hepatocellular carcinoma.

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Section: Discussionmentioning

confidence: 70%

Risk Factors for the Development of Postembolization Syndrome after Transarterial Chemoembolization for Hepatocellular Carcinoma Treatment

et al. 2018

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“…The microbiological cultures in the present study suggested a wide variety of causative organisms, including gram negatives such as E coli , (52.4%, 11/21) and E cloacae , (38.1%, 8/21), as well as gram positives such as E faecalis (28.6%, 6/21) and Staphylococcus epidermidis (9.5%, 2/21), which is different from the earlier studies. 6 , 18 A consensus on which antibiotic agent should be the first choice remains lacking to date. According to our bacterial spectrum, if liver abscesses following TACE are suspected, 3rd-generation cephalosporin and vancomycin should be used as the first-line antibiotics for obtaining a whole coverage of gram-positive and gram-negative organisms.…”

Section: Discussionmentioning

confidence: 99%

Liver Abscess Formation Following Transarterial Chemoembolization

et al. 2016

Medicine

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To investigate the clinical features, risk factors, and bacterial spectrum of liver abscess following transarterial chemoembolization (TACE) and evaluate the therapeutic effect of percutaneous catheter drainage (PCD) on the abscesses.A retrospective review of patient charts was performed in 3613 patients who suffered from liver malignancies (2832 patients with hepatocellular carcinoma and 781 with metastatic hepatic tumor) and had undergone 11,054 TACE procedures from January 2005 to October 2013. Liver abscesses were found in 21 patients. PCD was performed in all abscess patients. The clinical features, risk factors, and bacterial spectrum of liver abscess following TACE were investigated and the therapeutic effect of PCD was evaluated.The incidence of liver abscess was 0.58% per patient and 0.19% per procedure. Approximately 57.1% of the patients had a medical history of bilioenteric anastomosis or biliary stent implantation. On computed tomography scans, the abscesses appeared as low-attenuation lesions and high-density iodinate oil scattered in the abscesses. The ultrasound showed the well defined, heterogeneously hypoechoic lesions. Positive microbiological isolates were obtained in all pus cultures and in 47.6% of blood cultures. The most common bacterium was Escherichia coli (52.4%). Twenty patients (95.2%) were cured from abscesses by using PCD, and 1 died of sepsis.Patients with predisposing factors are prone to an increased risk of liver abscess following TACE. Bacterial culture and antibiotic sensitivity tests on pus and blood help on the antibiotics selection. PCD combined with aggressive antibiotics can be recommended as the first-line therapeutic regimen.

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“…Pyogenic hepatic abscess after HAE is rare, but is associated with significant morbidity and mortality,(6–10) especially in patients with advanced malignancy. (14–15) Moreover, abscess formation impairs recovery in patients who already suffer from terminal malignancy and may preclude future embolization procedures or other cancer-directed therapy.…”

Section: Discussionmentioning

confidence: 99%

Pyogenic Abscess after Hepatic Artery Embolization: A Rare but Potentially Lethal Complication

Mezhir

Fong

Fleischer

et al. 2011

Journal of Vascular and Interventional Radiology

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Background Hepatic artery embolization (HAE) is used commonly to treat liver tumors or hemorrhage. Infectious complications are rare, but carry high morbidity and mortality. Identification of clinical factors associated with post-embolization abscess may improve management and outcome. Methods Clinical and pathologic variables of patients treated with HAE were collected and analyzed to determine the etiology, incidence, and outcome of pyogenic hepatic abscess. Results From January 1998 to January 2010, 971 patients underwent 2,045 HAE procedures. Fourteen patients developed a pyogenic hepatic abscess following embolization for an overall rate of 1.4%. Thirty-four patients (4%) had a history of bilioenteric anastomosis (BEA) and 21 patients (2%) lacked a competent sphincter of Oddi due to the presence of a biliary stent (N=19) or a prior sphincterotomy (N=2). Eleven (33%) of the 34 patients with a BEA and 2 (10%) of 21 patients with an incompetent sphincter developed abscesses, in contrast to only 1 abscess (0.05%) among the 916 patients with apparently normal sphincters (0.1%, OR 437.6 (95% CI 54.2 – 3,533, p<0.0001). Gram negative and gram positive aerobes were the most common bacteria isolated following drainage. Percutaneous drainage was the initial management strategy in all patients; 2 patients (14%) required subsequent surgical drainage and hepatectomy and 3 (21%) died. Conclusion Pyogenic hepatic abscess is rare after HAE. A history of BEA or an incompetent sphincter of Oddi due to a biliary stent or prior sphincterotomy substantially increases in the likelihood of this highly morbid and potentially fatal complication.

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Liver abscess complicating transcatheter arterial embolization

Cited by 36 publications

References 24 publications

Risk Factors for the Development of Postembolization Syndrome after Transarterial Chemoembolization for Hepatocellular Carcinoma Treatment

Risk Factors for the Development of Postembolization Syndrome after Transarterial Chemoembolization for Hepatocellular Carcinoma Treatment

Liver Abscess Formation Following Transarterial Chemoembolization

Pyogenic Abscess after Hepatic Artery Embolization: A Rare but Potentially Lethal Complication

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