Fatal septic complication of transcatheter chemoembolization for hepatocellular carcinoma

A patient with hepatocellular carcinoma, associated segmental portal vein thrombosis, and accompanying pneumobilia, developed a liver abscess and sepsis following transcatheter chemoembolization (TCE). It was believed that the combination of bile duct necrosis after arterial occlusion and pneumobilia led to ascending enteric infection and seeding of the necrotic tumor, which ultimately led to fatal outcome. We conclude that TCE is contraindicated in such cases.