In 1993, a 55-year-old-man was diagnosed with
chronic active hepatitis (HCV). In January 1999, a solitary
hepatocellular carcinoma (HCC) was discovered in his liver S8, and a sub-segmental
hepatectomy was performed. In July 1999, multiple recurrences in the liver were noticed, and on August 6, 1999, the first
SMANCS-TAE was performed. After that, PEIT was added, and then on July 18, 2000 and November 9, 2000, a second and third
SMANCS-TAE were carried out, respectively. This time multiple HCCs in the bilateral lobes were discovered, and the 4 th
SMANCS-TAE was undergone on April 12, 2001. On a celiac angiogram, the right hepatic artery was shown to have been obliterated by the last TAE. In addition, accessory left gastric artery (accessory LGA) originating in the left hepatic artery (LHA) proximal to the umbilical point (UP) could be seen. So we advanced a microcatheter to the LHA distal to the accessory LGA and injected
SMANCS (0.8 mg) into the left hepatic artery. On April 24, he was admitted to hospital by ambulance due to severe upper
abdominal pain. The muscular defense was noticed, and an air pocket under the diaphragm was indicated on an X-ray. An emergency total
gastrectomy and R-Y re-construction were performed under the diagnosis of gastric perforation. A hole of approximately 10 cm in diameter was found in the anterior wall between the cardia and the upper body, and the accessory left gastric artery (LGA) was obliterated. The principal known side effects of
SMANCS are
fever,
nausea and
vomiting. However, as far as this writer has investigated, gastric perforation has never been reported.
SMANCS presumably can flow into the stomach wall through the accessory LGA, triggering
necrosis of the gastric wall due to circulatory damage. Although arterial infusion of
SMANCS is an effective treatment, it causes considerable vascular damage, so intensive follow-up treatment is necessary.