Liver Abscesses and An Intrahepatic Pseudoaneurysm caused by Arterial Infusion Therapy for Unresectable Pancreatic Cancer

We report a case of liver abscesses with an intrahepatic pseudoaneurysm caused by 5-fluorouracil(5FU) intraarterial infusion combined with systemic gemcitabine(GEM) for cancer of the head of the pancreas with metastatic liver tumors. A 65-year-old man undergoing chemotherapy without severe adverse events for 5 months was admitted for sudden septic shock onset, disseminated intravascular coagulation, and acute respiratory distress syndrome. He recovered after intensive treatment. Abdominal computed tomography(CT) on admission showed no infected foci. Serum alkalinephosphatase increased, although jaundice was not observed during intensive treatment. Abdominal CT after recovery showed multiple liver abscesses and an intrahepatic pseudoaneurysm. After completion of coil embolization for the pseudoaneurysm, the abscesses were drained percutaneously and cured completely. He was discharged symptom-free. Biliary and arterial toxicity due to arterial infusion of 5FU seemed to be the main cause of the abscesses. We assume that inflammation of liver abscesses spread to the hepatic arterial wall, resulting in the hepatic pseudoaneurysm.