Hepatic Arterial Infusion Chemotherapy via Reconstituted Proper Hepatic Artery From the Left Gastric Artery for Intrahepatic Cholangiocarcinoma, Complicated by the Formation of Arterio-Enteric Fistula: A Case Report

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary cancer in the liver. Hepatic arterial infusion chemotherapy (HAIC) is one of the several choices available in liver-directed therapy for inoperable patients. However, HAIC carries several potential complications, such as occlusion of the hepatic artery, gastric or duodenal mucosal lesions, catheter dislodgement, infection of the port-catheter system, and bleeding around the port system. We hereby report a case of a patient who had undergone repeated HAIC sessions for ICC by a rare pathway via a reconstituted proper hepatic artery (PHA) from the left gastric artery. The treatment course was complicated by the development of an arterio-enteric fistula between the PHA and the duodenal bulb. Subsequently, the tip of the catheter migrated into the duodenal lumen.