Case Report
Copyright ©2007 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Sep 7, 2007; 13(33): 4523-4525
Published online Sep 7, 2007. doi: 10.3748/wjg.v13.i33.4523
Hepatocellular carcinoma masquerading as a bleeding gastric ulcer: A case report and a review of the surgical management
Johnny CA Ong, Pierce KH Chow, Weng-Hoong Chan, Alex YF Chung, Choon Hua Thng, Wai-Keong Wong
Johnny CA Ong, Pierce KH Chow, Weng-Hoong Chan, Alex YF Chung, Wai-Keong Wong, Department of General Surgery, Singapore General Hospital, Singapore 169608, Singapore
Choon Hua Thng, Department of Oncologic Radiology, National Cancer Centre, Singapore, Singapore
Author contributions: All authors contributed equally to the work.
Correspondence to: Pierce Chow, Associate Professor, MD, PhD, Department of General Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore. gsupc@singnet.com.sg
Telephone: +65-63214051 Fax: +65-62209323
Received: June 4, 2007
Revised: June 12, 2007
Accepted: June 23, 2007
Published online: September 7, 2007
Abstract

Hepatocellular Carcinoma (HCC) is a common malignancy worldwide. While bleeding from the gastrointestinal tract (BGIT) has a well known association with HCC, such cases are mainly due to gastric and esophageal varices. BGIT as a result of invasion of the gastrointestinal tract by HCC is extremely rare and is reportedly associated with very poor prognosis. We describe a 67-year-old male who presented with BGIT. Endoscopy showed the site of bleeding to be from a gastric ulcer, but endoscopic therapy failed to control the bleeding and emergency surgery was required. At surgery, the ulcer was found to have arisen from direct invasion of the gastrointestinal tract by HCC of the left lobe. Control of the bleeding was achieved by surgical resection of the HCC en-bloc with the lesser curve of the stomach. The patient remains alive 33 mo after surgery. Direct invasion of the gastrointestinal tract by HCC giving rise to BGIT is very uncommon. Surgical resection may offer significantly better survival over non-surgical therapy, especially if the patient is a good surgical candidate and has adequate functional liver reserves. Prognosis is not uniformly grave.

Keywords: Hepatocellular carcinoma; Gastrointestinal bleeding; Stomach invasion; Hepatectomy