Sy. Song et al., Liver abscess after transcatheter oily chemoembolization for hepatic tumors: Incidence, predisposing factors, and clinical outcome, J VAS INT R, 12(3), 2001, pp. 313-320
PURPOSE: To evaluate the incidence of, predisposing factors for, and clinic
al outcome of liver abscess developing in patients with hepatic tumors afte
r transcatheter oily chemoembolization (TOCE).
MATERIALS AND METHODS: During the past 6-year period, 2,439 patients with h
epatic tumors underwent a total of 6,255 TOCE procedures. With a retrospect
ive review of medical records, the authors evaluated the occurrence of live
r abscess, the statistical significance of potential predisposing factors i
ncluding portal vein obstruction, metastatic tumors, biliary abnormalities
(type 1, simple biliary obstruction; type 2, status prone to ascending bili
ary infection), malignant gastrointestinal mucosal lesions, and additional
gelatin sponge particle embolization in liver abscess formation, and the cl
inical outcome of abscess.
RESULTS: Fifteen liver abscesses occurred in 14 patients (0.2%). Liver absc
esses developed in three of 987 (0.3%) TOCE procedures for portal vein obst
ruction, three of 114 (2.6%) procedures for metastatic tumors, one of 49 (1
.8%) for type 1 biliary abnormality, four of 55 (7.4%) for type 2 biliary a
bnormality, two of 18 (11.1%) for malignant gastrointestinal mucosal lesion
, and nine of 2,108 (0.4%) for additional gelatin sponge particle embolizat
ion. Univariate and multivariate statistical analysis showed that type 2 bi
liary abnormality was a significant predisposing factor. The mortality rela
ted to liver abscess occurred in two patients (13.3%). Thirteen liver absce
sses were successfully treated with parenteral antibiotics and percutaneous
catheter drainage. However, irreversible deterioration of liver function o
ccurred in two patients. Two of nine further TOCE procedures in three patie
nts caused recurrent septicemia and liver abscess.
CONCLUSION: The biliary abnormality prone to ascending biliary infection wa
s the most important predisposing fatter to the development of liver absces
s after TOCE. Postembolic liver abscess could be effectively managed with p
ercutaneous catheter drainage.