Case Report
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World J Gastroenterol. Nov 14, 2013; 19(42): 7472-7475
Published online Nov 14, 2013. doi: 10.3748/wjg.v19.i42.7472
Massive upper gastrointestinal hemorrhage due to invasive hepatocellular carcinoma and hepato-gastric fistula
Hari Sayana, Osama Yousef, Wendell K Clarkston
Hari Sayana, Osama Yousef, Wendell K Clarkston, Section of Gastroenterology and Hepatology, Department of Internal Medicine, University of Missouri Kansas City, Kansas City, MO 64108-2640, United States
Author contributions: Sayana H did the literature search, wrote and drafted the manuscript and reviewed; Yousef O, Clarkston WK critically reviewed and edited the manuscript; all authors reviewed and approved the final revised version.
Correspondence to: Hari Sayana, MD, Section of Gastroenterology and Hepatology, Department of Internal Medicine, University of Missouri Kansas City, 2301 Holmes Street, Kansas City, MO 64108-2640, United States. sayana_h@yahoo.com
Telephone: +1-913-9093652 Fax: +1-816-9325179
Received: June 26, 2013
Revised: September 3, 2013
Accepted: September 15, 2013
Published online: November 14, 2013
Processing time: 145 Days and 4.9 Hours
Core Tip

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.