Gastrointestinal hemorrhage in hepatocellular carcinoma: management with transheptic arterioembolization

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.