Published online Nov 14, 2013. doi: 10.3748/wjg.v19.i42.7472
Revised: September 3, 2013
Accepted: September 15, 2013
Published online: November 14, 2013
Processing time: 145 Days and 4.9 Hours
A 36-year-old male Asian immigrant with a history of hepatitis B and hepatitis C related unresectable hepatocellular carcinoma in the left lobe of the liver presented with hematemesis and severe anemia. He was diagnosed with a liver mass that was resected 8 years ago described as a benign tumor in his home country. He had received trans-arterial chemoembolization (TACE) four months ago after subsequent diagnosis of unresectable hepatoma, and currently was receiving chemotherapy with Sorafenib. After resuscitation, a contrast enhanced computerized tomography was performed which showed fistulization of hepatocellular carcinoma into adjacent stomach. This finding was confirmed during endoscopy with direct visualization of the fistulous opening. Hepatocellular carcinoma (HCC) invading the gastrointestinal (GI) tract is rare. We present a case and literature review of HCC with local invasion of the stomach causing massive upper GI bleeding after receiving TACE.
Core tip: Gastrointestinal bleeding is a common complication of hepatocellular carcinoma (HCC). However, HCC leading to Hepatogastric fistula presenting as massive upper gastrointestinal bleeding is uncommon. Here we report a case of HCC with direct invasion of the stomach leading to massive gastrointestinal bleeding. Patient was managed with selective arterial angiogram and coil embolization to control bleeding. HCC with local metastasis to adjacent structures such gastrointestinal tract carries poor prognosis. With increasing incidence of HCC and recent improvements in the treatment of advanced HCC, this condition may become more common and awareness among clinicians should help consider this condition in the differential diagnosis and prompt management.