Abstract
A 51-year-old male was admitted to our hospital complaining of tarry stool and epigastralgia. Findings on abdominal ultrasonography and computed tomography were compatible with those of liver cirrhosis and multiple space occupying lesions in the bilateral lobes. Hemorrhagic ulcer with hematoma and marginal elevation were seen in the duodenal bulb on endoscopy. The biopsy specimen repeatedly taken from the ulcer bottom revealed moderately differentiated hepatocellular carcinoma. Duodenal invasion was rapidly enlarged. Therefore it's appearance changed from small Borrmann 2 type to small Borrmann 1 during the two months after admission. He needed large amount of transfusion for bleeding from invasional ulcer. Abdominal angiography showed large tumor stain spreaded to duodenum and transarterial chemolipiodolization and embolization by spongel of left hepatic artery was performed on the 70th hospital days for the purpose of hemostasis. Soon after, tarry stool was disappeared and we carried out no transfusion. His cachexia was progressed and gradually died on the 110th hospital days. Reports on serial endoscopic findings of duodenal invasion from hepatocellular carcinoma and successful treatment by TAE for bleeding from invasional ulcer, we are few in number, and therefore our report may be valuable from these aspects.
