Content area
Full text
Received: November 3, 1999
Accepted: December 27, 1999
Key Words
Clostridium perfringens, sepsis Bile duct cancer. Chemoembolization . Hyperbaric oxygen Hemolysis
Abstract
A 65-year-old woman underwent resection of a distal common bile duct carcinoma (Whipple's procedure). Twelve months later a single hepatic metastasis was detected and a chemoembolization was performed. Immediately after chemoembolization the patient developed a multimicrobial sepsis including Clostridium perfringens. CT scans depicted pathognomonic signs of gas-containing abscess in the necrotic liver metastasis. She was subsequently treated with broad-spectrum antibiotics, abscess drainage and hyperbaric oxygen therapy. We conclude that antibiotic prophylaxis is recommendable for chemoembolization of liver metastasis in patients with risk factors like intestinal biliary reflux (bilioenteric anastomosis or papillotomy and biliary stenting) and bile duct cancer, otherwise severe sepsis including clostridium bacteremia may occur.
Copyright 2000 S. Karger AG, Basel
Introduction
Clostridial bacteremias are unusual but not extraordinary events. Mainly patients with malignancies such as acute leukemia, genitourinary or gastrointestinal tumors are affected. Clostridia grow fast under anaerobic conditions especially in tissue with low redox potential [ I ]. Chemoembolization of liver tumors induces necrosis which creates ideal growth conditions for anaerobic bacteria. Mediated by necrotizing and hemolyzing toxins, fulminant courses of clostridial infections occur with fever, hemolysis and septic shock, leading to death within 24 h if therapeutic measures are not taken immediately. We report a case of multimicrobial sepsis including Clostridium perfringens after chemoembolization of a hepatic metastasis from bile duct cancer.
Case Report
A 65-year-old woman with a carcinoma of the common bile duct was treated by duodenopancreatectomy, cholecystectomy and hepaticojejunostomy (Whipple's procedure). A regular follow-up CT examination 12 months after surgery revealed a single intrahepatic metastasis (4 x 3 x 3 cm, segment 7). MR imaging confirmed this metastasis without signs of abscess or necrosis. Transcatheter arterial chemoembolization (TACE) of the single liver metastasis was performed with 25 mg epirubicin emulsified in 2.5 ml iodized oil (Lipiodol) and with 25 mg cisplatin dissolved in 10 ml physiologic saline solution with the addition of 300 mg starch microspheres (Spherex). They were mixed just before injection using the usual push-and-pull method with two syringes connected by a three-way stopcock. The lesion could not be detected in the angiogram because it was not hypervascular. Therefore the catheter...