Gastrointestinal hemorrhage in hepatocellular carcinoma: management with transhepatic arterioembolization

Abstract

Gastrointestinal hemorrhage in patients with hepatocellular carcinoma is common and a major contributor to mortality. These patients tend to have a very poor prognosis. This report describes five such cases in which gastrointestinal bleeding was one of the presenting problems and required urgent management. The causes of massive intermittent gastrointestinal bleeding were variceal (two cases), direct invasion of the duodenum (one case), transverse colon (one case), and stomach (one case). All five patients were inoperable because of locally advanced disease, poor general condition, or comorbid disorders and were managed with angioembolization. After transcatheter embolization, the bleeding stopped completely in two patients and was reduced significantly in the remaining three. We report the role of transhepatic arterioembolization in the management of gastrointestinal bleed in such patients, and we recommend its use more often in similar situations.

Upper Gastrointestinal Bleeding in Oncological Patients

“…Embolization is restricted to areas where the blood vessels are accessible by the catheter and where embolization of the blood vessel does not result in the ischemia of key organs [37]. In a review that included patients undergoing embolization for upper gastrointestinal bleeding, complications occurred in 5% to 9% of the patients (bowel ischemia and infarction accounted for the majority of complications) [38] (Table 7).…”

Direct invasion to the colon by hepatocellular carcinoma: Report of two cases

“…The most frequently invaded GI tract sites are the duodenum and stomach [2] and invasion into the colon is very rare. To date, only eight cases of invasion to the colon by HCC have been reported in the English literature (Table 1) [2,3,[9][10][11] . Among the 10 patients (including our two cases), the most frequent symptom was bloody stool (8 of 10 patients, 80%).…”

Management of Bleeding in Patients with Advanced Cancer

“…Embolization is restricted to areas where the blood vessels are accessible by the catheter and where embolization of the blood vessel does not result in ischemia of key organs. Benefits have been reported in patients with cancers involving the head and neck [57][58][59], pelvis [60][61][62][63][64], lung [43,44,61,65], liver [66], and gastrointestinal tract [67]. As with other treatment options in this setting, the majority of the evidence supporting this modality relies on case reports.…”

“…Transhepatic arterioembolization was used to control bleeding in five patients with inoperable hepatocellular cancer who presented with gastrointestinal bleeding from a variety of sources (esophageal varices or direct invasion of the duodenum, transverse colon, or stomach) [67]. Recordare and colleagues described four patients who underwent TAE to control spontaneous rupture of hepatocellular carcinoma [66].…”