RESUMO
INTRODUCTION: Transarterial hepatic chemoembolization (TACE) has been used to treat unresectable hepatocellular carcinoma and has gained widespread acceptance as a treatment for both primary and secondary hepatic malignancies. CASE REPORT: We report a case of 78-year-old male patient with chronic hepatitis B, diagnosed with HCC. He underwent the second TACE, and right after the procedure, the patient abruptly developed bilateral lower extremities motor weakness and sensory impairment below the T10 dermatome. Spinal magnetic resonance imaging showed T2-weighted scans showed increased intramedullary signal strength at the T1-T12 level. The patient received supportive care, ongoing rehabilitation, and steroid pulse therapy. The motor strength remained unchanged, but the sensory deficiencies practically disappeared. CLINICAL DISCUSSION: The hepatic artery injury or decreased flow at the prior TACE site, which causes collateral recruitment, can explain why spinal cord injury following TACE typically happens after the second or third session. It can occasionally result from accidental embolized spinal branches originating from intercostal or lumbar collateral arteries. In our case, we hypothesize the embolism caused the infarction to the spinal cord travel through the connection between the lateral branches of the right inferior phrenic artery and the intercostal arteries, which supply the spinal cord through the anterior spinal artery. CONCLUSIONS: TACE in rare case can have severe complications. A tailored therapeutic strategy, including consideration of a shunt and selection of the vessels utilized for the Lipiodol infusion prior to TACE, is crucial to achieving an optimal end outcome to avert these significant consequences.
RESUMO
INTRODUCTION: Chronic pancreatitis is characterized by irreversible structural damage, including fibrosis and compression of the pancreatic ducts, often leading to stones forming in the pancreatic duct and parenchyma. Surgery is indicated when severe obstruction with chronic pain is presented and conventionally drained by pancreatojejunostomy. CASE REPORT: A 56-year-old female patient with epigastric pain for many years. Computed tomography revealed an atrophic pancreas with a dilated pancreatic duct (18 mm) obstructed by a stone sized 1.3 cm. The patient underwent laparoscopic pancreatic duct exploration, used electrohydraulic lithotripsy for pancreatic duct stones, and then placed pancreaticoduodenal internal drainage with primary closure of the pancreatic duct. The operative time was 185 min, and the total blood loss was around 50 ml without intraoperative complication. The patient was discharged from the hospital on postoperative day 5 uneventfully. The epigastric pain symptoms dramatically decreased in the follow-up visit after one month. CLINICAL DISCUSSION: We combined several minimally invasive techniques to treat a chronic pancreatitis patient with a stone forming in the main duct in this patient. We used lithotripsy and internal drainage without the need for anastomosis. To our knowledge, this is the first report on this technique in literature. We found this technique is safe and applicable in selected patients to treat pancreatic stones with the dilated pancreatic duct. CONCLUSIONS: In this case, we demonstrate a novel surgical treatment option for chronic pancreatitis with a simple and effective technique to manage pancreatic stones in chronic pancreatitis patients.
