Lethal necrotizing pancreatitis complicating a "one shot" percutaneous ethanol injection into a multifocal hepatocellular carcinoma: Case report.

Abstract

ABSTRACT: There are no reports in the literature of acute pancreatitis after "one shot" percutaneous ethanol injection (PEI); in contrast, cases of lethal acute pancreatitis are described as a complication of intraarterial PEI. We report a case of a lethal necrotizing pancreatitis resulting from a "one shot" PEI into a multifocal hepatocellular carcinoma (HCC). Deaths after PEI occur between a few hours and a few days after the event because of hemoperitoneum and haemorrhage from oesophageal varices and the major complications are renal insufficiency, hemoperitoneum and hepatic insufficiency. None of these complications occurred in our patient immediately after PEI. We believe that PEI initially caused the edematous pancreatitis through a detrimental metabolic effect. Thereafter, the ensuing treatment with opioids (to reduce the patient's abdominal pain) led to toxic effects causing, together with PEI, the development of lethal necrotizing pancreatitis.