• Byung Chan Lee, Hyoung Ook Kim, Chan Park, Inwoo Choi, and Seung Wan Kang.
• Department of Radiology, Chonnam National University Hwasun Hospital and Chonnam National University Medical School, Hwasun-eup, Hwasun-gun, Jeollanam-do, South Korea.
• Medicine (Baltimore). 2024 Sep 13; 103 (37): e39632e39632.

RationaleOwing to the abundant collateral blood supply to the duodenum, the development of a hepatoduodenal fistula after transarterial chemoembolization (TACE) is an extremely rare complication that usually requires hospitalization and intensive medical intervention. Here, we report a case of a silent hepatoduodenal fistula following TACE.Patient ConcernsA 74-year-old man with a history of alcoholic liver cirrhosis and type 2 diabetes. He had undergone a partial hepatectomy due to hepatocellular carcinoma (HCC) 7 years ago. In addition, he had undergone 4 TACEs for the treatment of recurrent HCCs but still had a viable tumor in S4b of the liver, which abuts the duodenal 1st portion.DiagnosesHCC.InterventionsThe patient underwent a 5th TACE and was discharged from the hospital without major adverse events.OutcomesFollow-up computed tomography scans showed a 2 cm-sized air cavity instead of a compact Lipiodol-laden tumor in S4b, which had shrunk over time. The patient had experienced a fluctuating nonspecific mild fever for 3 months, with improvements in symptoms and laboratory findings following conservative treatment alone.LessonsHepatic fistulas may arise following TACE for HCCs near the gastrointestinal tract and may be present with nonspecific symptoms. This case suggests that increased efforts should be directed toward achieving selective embolization when treating HCC adjacent to the gastrointestinal tract, with close monitoring required after treatment.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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