Acute cholecystitis as a complication following percutaneous ethanol injection of a hepatocellular carcinoma

Percutaneous ethanol injection is a useful option in the treatment of hepatocellular carcinoma which are not amenable to resection or transplantation. We describe a case of cholecystitis and tumour infiltration of the gallbladder after percutaneous ethanol injection, a complication not previously described in literature. The patient was a 70-year-old woman with a history of asymptomatic HCV+ hepatopathy and a 6 cm hepatocellular carcinoma nodule in segment V which had been treated two months before by percutaneous ethanol injection in another center. She attended our center due to febrile syndrome. Imaging studies suggested cholecystitis with an abscess on the wall of the gallbladder, purulent material obtained by means of a CT-guided puncture. Surgery revealed purulent and neoplasic material inside the gallbladder, with tumor invasion of the posterior wall; a partial cholecystectomy was therefore performed and a drainage inserted. The patient showed no post-operative complications and was discharged after seven days.

we believe that the percutaneous ethanol injection of hepatocellular carcinomas located close to the gallbladder may occasionally lead to complications in the form of cholecystitis with neoplasic infiltration of the gallbladder. A case of cholecystitis secondary to radiofrequency treatment of a similarly-located tumor has previously been described and, therefore, the use of percutaneous local destructive treatments for tumors close to the gallbladder would seem unadvisable.