Severe gangrene of the stomach and infarction of the liver and spleen after percutaneous ethanol injection for hepatocellular carcinoma: Report of a case

Percutaneous ethanol injection is a safe and effective treatment for small hepatocellular carcinoma. The complication rate is lower in the injury of liver, stomach and spleen. We herein report an 82-year-old female with chronic hepatitis C-related hepatocellular carcinoma, measuring 4.0×2.8 cm in the left lobe of liver. Because of high risk of surgery, she received percutaneous ethanol injection in segmental fractions with 1-2 cc in one fraction, total 20 milliliter of 95% ethanol in one session, and then soon suffered complications of gangrene of the stomach and infarction of the liver and spleen. Although surgical intervention and intensive care were administrated, she finally died of sepsis with multiple organ failure. The mechanism of percutaneous ethanol injection-related injuries to a combination of stomach, liver and spleen is probably vascular injury by ethanol. It is recommended that a slower injection speed, small amounts of ethanol during procedure and assessment of vascular anatomy before percutaneous ethanol injection are needed to avoid such severe ethanol-induced vessel injury.