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British Journal of Radiology (2009) 82, e105-e107
© 2009 British Institute of Radiology
doi: 10.1259/bjr/63705954
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British Journal of Radiology 82 (2009),e105-e107 ©2009 The British Institute of Radiology

Delayed spontaneous hepatogastric fistula formation following transcatheter arterial embolisation and radiotherapy for hepatocellular carcinoma

C-Y WANG, MD S W LEUNG, MD 3 J-H WANG, MD 4 P-C YU, MD 5 and C-C WANG, MD

1 National Kaohsiung University of Applied Sciences, 2 Department of Radiation Oncology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, 3 Department of Radiation Oncology, Yuan's General Hospital and Departments of, 4 Hepatogastroenterology, 5 Radiology and 6 General Surgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan

Correspondence: Chang-Yu Wang, Department of Radiation Oncology, Chang Gung Memorial Hospital-Kaohsiung Medical Center. No 123, Dapi Road, Niaosong Township, Kaohsiung County 833, Taiwan, Republic of China. E-mail: cywang{at}adm.cgmh.org.tw

A 58-year-old male patient with an unresectable 10 cm liver lesion that was a histologically proven hepatocellular carcinoma (HCC) underwent transcatheter hepatic artery embolisation (TAE). 4 months later, the patient was referred for salvage radiotherapy owing to local recurrence. The HCC became an encapsulated tumour with central necrosis after radiotherapy. The patient enjoyed a normal lifestyle for 9 years, with local control achieved by radiotherapy, until a hepatogastric fistula developed. Although the hepatogastric fistula resolved with surgical drainage, the patient later died from septic shock. Hepatogastric fistula is a rare but serious complication after TAE and radiotherapy for HCC. Development of fever, abdominal pain and jaundice after an initial symptom-free interval should arouse suspicion of hepatogastric fistula formation from an encapsulated necrotic HCC or a ruptured liver abscess. Because the mortality is high, aspiration of a suspected necrotic lesion should be performed as soon as possible. Patients with risk factors, including liver cirrhosis and large lesions close to the adjacent gastrointestinal tract, are especially vulnerable. Gas formation within a necrotic liver tumour requires immediate drainage.






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