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Gangrenous cholecystitis as a complication of hepatic artery embolization: case report
R K Simons1, M N Sinanan, D M Coldwell
1Department of Surgery, University of Washington, Seattle.
Insights
Hepatic artery embolization can cause gallbladder ischemia, leading to gangrenous cholecystitis. This study highlights three cases requiring surgery, differentiating it from postembolization syndrome.
Area of Science:
- Interventional Radiology
- Hepatobiliary Surgery
- Gastroenterology
Background:
- Hepatic artery embolization (HAE) is a common interventional radiology procedure.
- Gallbladder ischemia is a known but infrequent complication of HAE.
- It is typically considered a minor complication, often overshadowed by postembolization syndrome.
Observation:
- Three patients developed symptomatic, gangrenous cholecystitis following therapeutic HAE.
- These cases presented with severe symptoms necessitating urgent surgical intervention.
- The clinical presentation mimicked, but was distinct from, the typical postembolization syndrome.
Findings:
- Symptomatic gangrenous cholecystitis is a significant, albeit rare, complication of HAE.
- Distinguishing this ischemic septic process from postembolization syndrome is crucial for timely management.
- Early recognition and surgical intervention are key for favorable outcomes.
Implications:
- Clinicians should maintain a high index of suspicion for gangrenous cholecystitis post-HAE.
- Diagnostic parameters to differentiate this complication from postembolization syndrome are essential.
- Revised management protocols may be needed to address this serious complication effectively.
Abstract:
Ischemic injury to the gallbladder has been described after hepatic artery embolization but has not been considered a clinically significant complication of this procedure. We present three cases in which therapeutic embolization resulted in symptomatic gangrenous cholecystitis requiring urgent surgical intervention. Clinical parameters that distinguish this infrequent ischemic septic process from the more common postembolization syndrome are discussed and recommendations concerning the diagnosis and management of these complicated patients are outlined.