Massive and life-threatening upper gastrointestinal bleeding due to invasive hepatocellular carcinoma: A case report

• Hepatocellular carcinoma (HCC), which constitutes more than 90% of primary liver cancers, is a major global health problem.
• In HCC, 30% of cancer related deaths is due to hepatic failure, and 10% is due to gastrointestinal (GI) bleeding. GI metastasis is reported as 0.4-2%. GI bleeding frequency due to HCC direct invasion is 0.05-2%, and may be fatal.
• Besides, the repetition of TAE, intra-arterial chemotherapy, radiotherapy, and individualized treatment plans have recently increased survival in unresectable HCC patients, and thus it is expected that GI involvement will be more commonly encountered in HCC patients in the near future.

BackgroundThe mean survival is less than 6 months in hepatocellular carcinoma (HCC) patients with extrahepatic metastasis. Gastrointestinal(GI) bleeding frequency due to HCC invasion is 0.05% to 2.0%, and may be fatal.Case presentationWe encountered a case of HCC with direct invasion to the gastrium that caused a life-threatening upper GI bleeding. Our patient was a 62 year old male who was a heavy smoker and drinker for almost 30 years. He had several upper GI bleeding episodes during the previous 6 months. Computed tomography (CT) revealed a 13 cm liver tumour directly invading the gastrium. Partial hepatic resection and subtotal gastrectomy were performed. Unfortunately, the patient died at the intensive care unit postoperatively due to hepatic failure.DiscussionAlthough the prognosis of HCC that has invaded the gastrium is very poor due to the advanced stage of the disease, surgical resection may be a favourable treatment option for patients with a massive upper GI bleeding.ConclusionsThe incidence of patients with massive bleeding due to gastric invasion of HCC is low, and only a few cases have been reported in the literature. Our purpose while presenting this rare case is to increase the awareness about the issue.