Serious bile cast formation after transarterial chemoembolization for liver cancer

We report the successful treatment of serious bile cast formation after transarterial chemoembolization (TACE) for liver cancer associated with the recurrence of liver cancer in a 51-year-old male. About 15 months after TACE, he developed serious bile cast formation and liver dysfunction. Before the operation, imaging data showed that the right hepatic hilus was involved and thus blocked the left hepatic duct which led the left hepatic duct to dilatate. But during surgery, we found serious bile cast with necrosis of mucous membrane inside the right hepatic duct and its almost all branches, which stretched out and blocked the join of the left and right hepatic duct and led the left hepatic duct to dilatate obviously. This case demonstrates that when patient develops bile duct complications associated with the recurrence of liver cancer after TACE, diagnosis must be cautious. It should be borne in mind that injury of the blood supply might be the cause of the severe bile duct complication of TACE.