1315 Groove Pancreatitis as a Rare Complication of TACE

Abstract

INTRODUCTION: Transarterial chemoembolization (TACE) is often performed for hepatocellular carcinoma. Side effects can occur due to arterial ischemia and cytotoxicity from chemotherapy delivery. TACE can be complicated via inadvertent embolization of arteries supplying the liver, gallbladder, stomach and pancreas. The association of acute pancreatitis with TACE is rare. The proposed mechanism involves regurgitation of embolic beads from the hepatic artery into the arterial supply of the pancreas. Acute pancreatitis can develop up to 15 days after TACE. Herein we present a case of groove pancreatitis occurring after TACE. Groove pancreatitis is a rare variant of focal chronic pancreatitis affecting the area between the head of the pancreas, duodenum, and the common bile duct. Functional and anatomical obstruction of the minor papilla from viscous pancreatic secretions leads to impaired pancreatic enzyme outflow and proliferation of Brunner's glands causing pancreatitis. Imaging may show a submucosal mass which may confound the diagnosis since pathologies including leiomyoma, gastrointestinal stromal tumor and ampullary carcinoma may have similar imaging findings. Groove pancreatitis remains largely unfamiliar to most physicians thus making its true incidence a challenge. CASE DESCRIPTION/METHODS: This is the case of a 69-year-old male patient with multicentric hepatoma secondary to chronic Hepatitis C, status-post TACE who presented to ER with a nine-day history of epigastric abdominal pain and nausea. The patient had received TACE nine days prior and was admitted with the diagnostic impression of acute pancreatitis. The physical exam was remarkable for flank pain, negative murphy's sign. Labs showed stable hemoglobin and platelet levels. Liver chemistry showed a mixed pattern with AST minimally elevated and ALT at 102, Alk Phos at 225, Amylase slightly elevated at 135 and lipase elevated at 161. Imaging studies showed acute pancreatitis with possible necrotic collection of 2.1 cm at the pancreatic head and uncinate process, duodenitis, mild gallbladder wall thickening and no ductal dilation. Likely etiology was pancreatitis secondary to recent TACE. DISCUSSION: Pancreatitis is a rare complication of TACE. Although elevated pancreatic enzymes may be seen in up to 40% of TACE cases, the incidence of symptomatic pancreatitis after TACE is low at 2%-4%. Despite this low incidence, it is a complication that one should be aware of in patients undergoing TACE procedure given its high morbidity and mortality.