Acute Ischemic Cholecystitis After Transarterial Chemoembolization of Hepatocellular Carcinoma: Incidence and Clinical Outcome

Purpose: To determine the incidence and clinical outcome of acute ischemic cholecystitis after transarterial chemoembolization (TACE) of hepatocellular carcinoma. Materials and Methods: In this ethics board-approved study, a retrospective review of 355 TACE procedures performed in 246 patients during a 5-year period was performed. The review of postintervention computed tomography (CT) reports for findings indicative of acute cholecystitis identified 12 patients (4.9%). In these patients, all CT scans, laboratory results (white blood cell count, alkaline phosphatase level, total bilirubin level), and clinical reports were analyzed to assess imaging findings and outcomes at the following time points: before TACE, within the first week after the procedure, as well as 1 and 6 months post-TACE. Results: In 11 of 12 cases, the dominant finding on CT was new gallbladder wall thickening of up to 12 mm, which developed within 24 hours in 10 patients and within the first month after TACE in 1 patient. Gallbladder wall thickening persisted in 1 patient for at least 6 months. Eleven of 12 patients showed deposition of Lipiodol in the gallbladder wall. In 1 patient, the dominant finding on CT was peri-cholecystic stranding that resolved on follow-up CT after 1 month. None of the patients demonstrated gas in the gallbladder wall, significant peri-cholecystic fluid, abdominal or liver abscesses. Blood work results revealed transient increase in white blood cell count, alkaline phosphatase level, and total bilirubin level, not different from that seen after TACE in patients without CT evidence of cholecystitis. Clinical reports documented transient right upper quadrant pain for a few days and up to 1 month in 1 case with eventual symptom relief. None of the cases required surgical or radiological intervention. All but 1 case demonstrated normal gallbladder wall thickness after 6 months. Conclusions: Acute ischemic cholecystitis is not an uncommon complication after TACE. However, it is self-limiting and does not seem to require any intervention or surgery.