Peritoneal bleeding due to percutaneous transhepatic gallbladder drainage: An autopsy report.

A 77-year-old man underwent percutaneous transhepatic gallbladder drainage (PTGBD) for acute cholecystitis as a preoperative procedure; however, he suddenly suffered cardiopulmonary arrest 4 h after the PTGBD and died. There were three centesis scars for the PTGBD, and only one pathway from the most dorsal centesis scar reached the gallbladder. Microscopically, the PTGBD pathway crossed and injured the intrahepatic arterial wall, and hepatic parenchymal bleeding extended along the PTGBD pathway to the inferior surface of the liver. Blood flowed to the peritoneal cavity through a small gap between the liver and gallbladder. Consequently, the PTGBD caused lethal bleeding. When the percutaneous transhepatic cholangio drainage/PTGBD pathway runs close to vessels near the liver surface, it might be necessary to deal with the possibility of rapid and lethal peritoneal bleeding.

[A case of ruptured common hepatic arterial pseudoaneurysm and penetration into duodenum related with hepatic artery infusion chemotherapy].

In a 64-year-old male patient, liver metastasis recurred after surgery for transverse colon cancer. He received 6 courses of continuous intra-arterial infusion therapy with a catheter for hepatic intra-arterial infusion, which was retained by the GDA-coil technique. In April 2005, the patient suddenly developed hematemesis, and he was hospitalized for emergency treatment. Upper gastrointestinal endoscopy on the day after hospitalization revealed no distinct source of bleeding. Since he had massive hematemesis again on hospital day 4, endoscopic examination was repeated, which revealed that the metallic coil for embolization retained in the gastroduodenal artery protruded from the superior wall of the duodenal bulb with bleeding. Emergency angiography revealed that the bleeding arose from rupture of a common hepatic artery aneurysm. Hemostasis was induced by embolization of the region ranging from the right and left hepatic arteries to the entire common hepatic artery aneurysm with the metallic coil. The present case revealed serious complications of the hepatic intra-arterial chemotherapy and intra-arterial retention of the catheter.