A CASE OF HEPATOCELLULAR CARCINOMA ASSOCIATED WITH HEMOBILIA IN WHICH ENDOSCOPIC NASOBILIARY DRANAGE AND UROKINASE INFUSION WAS USEFUL FOR IMPROVING JAUNDICE

Abstract

A 60-year-old woman was admitted to our hospital because of right hypochondralgia. Laboratory data showed liver dysfunction with a high level (3600 ng/ml) of alphafetoprotein. Various imaging studies revealed a tumor in the right posterior segment of the liver and a metastasis to the lymphnode in hepatoduodenal ligament compressing the common bile duct. In spite of the chemotherapy, the size of metastatic tumor was increasing. Epigastralgia and jaundice appeared suddenly, and various imaging studies revealed hemobilia and obstruction of the common bile duct due to clots. Endoscopic nasobiliary dranage (ENBD) and urokinase infusion were performed immediately, which was very successful for improving the symptoms. However five months after admission she died of hepatic failure. and the autopsy revealed hepatocellular carcinoma associated with cirrhosis, and the metastatic tumor of 9 cm in size was also found in the hepatic hilus invasing into the common bile duct. ENBD was thought to be a useful therapeutic tool for hemobilia caused by carcinoma.