Common hepatic duct necrosis following transarterial chemoembolization for hepatocellular carcinoma: A case report and literature review

Abstract

Introduction

Transarterial chemoembolization (TACE) is an effective hepatocellular carcinoma (HCC) treatment. However, it can lead to complications such as bile duct necrosis, which may cause severe morbidity and require complex management.

Case presentation

A 58-year-old male with hepatitis B-associated HCC developed progressive jaundice and cachexia following TACE. Imaging revealed bile duct necrosis at the biliary bifurcation with intrahepatic duct dilation. Endoscopic and percutaneous interventions were considered but deemed inadequate due to the extent of bile duct injury, prompting surgical management with segment 4b segmentectomy and hepaticojejunostomy. This approach restored biliary continuity and alleviated symptoms effectively.

Clinical discussion

Bile duct necrosis following TACE lacks standardized treatment protocols, posing therapeutic challenges. Surgery, though invasive, offers a definitive solution for extensive injury, especially when balanced against oncologic needs and patient comorbidities like cirrhosis. This case highlights the value of individualized, multidisciplinary strategies.

Conclusion

Surgical intervention can be a viable option for bile duct necrosis following TACE when conservative measures fail. Early recognition and tailored management at specialized centers are critical for optimizing outcomes in this rare but severe complication.