Abstract

A 59-year-old male patient with chronic hepatitis B and liver cirrhosis was admitted due to fever and right upper quadrant (RUQ) pain. Two years ago, he had been diagnosed with hepatocellular carcinoma with bile duct invasion and underwent left lateral segmentectomy of liver and cholecystectomy. One year after, hepatocellular carcinoma recurred in the 4th and 5th segments and transarterial chemoembolization was done for them 3 times at 2 or 3 month intervals. On this visit, he complained of general weakness, RUQ pain, fever, and weight loss. Total bilirubin was 3.1 mg/dL, ALT/AST was 81/109 IU/L, and AFP was 2.14 ng/mL. Abdomen computed tomography showed diffuse dilatation of both intrahepatic bile ducts and several small low density lesions with rim enhancement in the 4th and 8th segments. Cholangitis with liver abscesses was suspected and treatment with antibiotics started. ERCP showed narrowing of proximal and hilar portions of common bile duct and irregular shaped filling defects in the right anterior, posterior and left medial portion of intrahepatic ducts, which were believed as tumor thrombi. Despite of endoscopic retrograde biliary drainage, he died of aggravated biliary sepsis and hepatic failure.

• Keywords: Bile duct invasion, Hepatocellular carcinoma;Hepatocellular carcinoma