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

## TL;DR

This case report describes a rare complication of transarterial chemoembolization for liver cancer, where surgery was needed to treat bile duct necrosis and restore function.

## Contribution

The paper presents a novel case of bile duct necrosis following TACE and advocates for surgical intervention as a definitive treatment option.

## Key findings

- Bile duct necrosis following TACE is rare but can require surgical management.
- Surgery can effectively restore biliary continuity and alleviate symptoms in severe cases.
- Early recognition and multidisciplinary strategies are critical for managing this complication.

## Abstract

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.

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.

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.

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.

•Bile duct necrosis following TACE is a rare complication.•A high degree of clinical suspicion is needed to promt diagnosis and treatment.•Surgery offers a definitive solution for extensive bile duct necrosis.

Bile duct necrosis following TACE is a rare complication.

A high degree of clinical suspicion is needed to promt diagnosis and treatment.

Surgery offers a definitive solution for extensive bile duct necrosis.