Abdominal Pain Following Drug-eluting Bead Transarterial Chemoembolization

Abstract

A 60 year old male presented with a two day history of fevers and right upper quadrant pain. His past medical history was significant for Child Pugh B cirrhosis secondary to chronic hepatitis B and he had received drug-eluting bead transarterial chemoembolization (DEB-TACE) for a 14 mm segment 7 hepatocellular carcinoma three weeks prior to this presentation. His other co-morbidities included a non-occlusive chronic portal vein thrombosis and stage III chronic kidney disease related to previous obstructive uropathy and nephrolithiasis. His only medication was entecavir 0.5 mg daily. Computed tomography (CT) of the abdomen and ultrasound of the gallbladder prior to therapy with DEB-TACE are shown in Figures 1 and 2, respectively. Figure 1 Computed tomography (CT) of the abdomen. Figure 2 Ultrasound of the gallbladder prior to therapy with DEB-TACE. At presentation he had a temperature of 37.6 °C and abdominal examination revealed a soft and non-tender abdomen and Murphy's sign was negative. Bowel sounds were present and there was no jaundice. Investigations showed a white cell count of hemoglobin of 128 g/L (normal range 130–170 g/L) 1.5 × 109/L (normal range 4.0–10.0 × 109/L) with neutrophils of 0.66 × 109/L (normal range 2.0–7.0 × 109/L) and lymphocytes of 0.36 × 109/L (normal range 0.20–1.0 × 109/L) and platelets of 54 × 109/L (normal range 150–410 × 109/L). Liver function tests were similar to previous levels, with a normal bilirubin, alkaline phosphatase and alanine transferase, an albumin of 26 g/L and an International Normalised Ratio (INR) of 1.3. A triple phase CT of the abdomen was performed, with the arterial phase image shown in Figure 3. An ultrasound of the abdomen was also performed, with gallbladder views shown in Figure 4. Figure 3 Triple phase CT of the abdomen, with the arterial phase image. Figure 4 Ultrasound of the abdomen was also performed, with gallbladder views.