The complicated management of a patient following transarterial chemoembolization for metastatic carcinoid

• Main Authors: Shah Manisha H, Steinberg Steven, Pearson Andrew C, Bloomston Mark
• Format: Article
• Language: English
• Published: BMC 2008-11-01
• Series: World Journal of Surgical Oncology
• Online Access: http://www.wjso.com/content/6/1/125

<p>Abstract</p> <p>Background</p> <p>Transarterial Chemoembolization (TACE) has been recognized as a successful way of managing symptomatic and/or progressive hepatic carcinoid metastases not amenable to surgical resection. Although it is a fairly safe procedure, it is not without its complications.</p> <p>Case presentation</p> <p>This is a case of a 53 year-old woman with a patent foramen ovale (PFO) and mild pulmonary hypertension who underwent TACE for progressive carcinoid liver metastases. She developed acute heart failure, due to a severe inflammatory response; this resulted in pneumatosis intestinalis due to non-occlusive mesenteric ischemia. We describe the successful non-operative management of her pneumatosis intestinalis and the role of a PFO in this patient's heart failure.</p> <p>Conclusion</p> <p>TACE remains an effective and safe treatment for metastatic carcinoid not amenable to resection, this case illustrates the complexity of complications that can arise. A multi-disciplinary approach including ready access to advanced critical care facilities is recommended in managing such complex patients.</p>