Abstract
Hemorrhage from hepatocellular carcinoma(HCC)directly invading the gastrointestinaltract is uncommon. A 61-year-old man, who had been treated HCC in our hospital since 1993, was admitted complaining of hematemesis in June 1996. On endoscopic examination, werecognized bleeding in the duodenal bulb and successfully stopped the bleeding by directinjectionor hypersodium epinephrine solution. Simultaneously, the findings of abdominal computedtomography showed recurrent HCC in S6. We performed transcatheter chemo-lipiodolizationagainst the recurrent HCC. Since 5 days after the chemo-lipiodolization he had had tarry stoolsfor 3 days. The second endoscopic examination showed tumor emerging in the duodenal bulb.Biopsy of the tumor revealed moderately to poorly differentiated hepatocellular carcinoma.Further computed tomography and ultrasonography confirmed direct invasion to the duodenumof the HCC. The duodenal tumor gradually reduced its size by the chemo-lipiodolization.However, computed tomography showed recurrence of the HCC in May 1997, and endoscopicexamination also showed a relapsed tumor in the duodenum. Therefore, we performed transcatheter arterial embolization and percutaneous ethanol injection therapy against the HCC.Soon after, the duodenal tumor transformed from Borrman type l into Borrman type 2, andfinally disappeared. He had had no gastrointestinal bleeding from the duodenum invaded byHCC since the initial therapy in June 1996 until he died of hepatic failure with tumor thrombosisof portal vein in January 1998. There have been few reports of chronological endoscopicobservation of HCC invading the duodenum. Furthermore, it was shown that endoscopicinjection of hypertonic sodium epinephrine solution directly to the tumor could stop its bleeding.
