A case report of a pseudoaneurysm formed in a biloma after intrahepatic arterial chemotherapy for hepatic metastases presented with melena of unknown origin

Abstract

This paper present a case of a pseudoaneurysm formed in a biloma after intrahepatic arterial chemotherapy for hepatic metastases of colon carcinoma presented with melena of unknown origin. Right hemicolectomy, cholecystectomy and hepatic arterial catheterization were performed for a 73-year-old man with carcinoma of the ascending colon and multiple liver metastases. Hepatic infarction and intrahepatic biloma were diagnosed 5 months after intrahepatic arterial chemotherapy with 5-fluorouracil (5-FU) and this treatment was changed to systemic chemotherapy with CPT-11. Liver metastases disappeared in one year after this treatment. The patient was followed up without chemotherapy and was admitted to our hospital because of melena. Abdominal CT scan was performed three times after hospitalization with a diagnosis of a pseudoaneurysm and MRI detected its rupture into the biloma. Angiographic embolization with micro coils for the pseudoaneurysm successfully controlled melena. Another pseudoaneurysm of other intrahepatic artery was formed to cause melena 5 months after this treatment and the second embolization controlled it. We should bear in mind that a biloma after intrahepatic arterial chemotherapy can cause repeated formation of pseudoaneurysm in the close intrahepatic artery.