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Chang CW, Wang HW, Huang WH, Chuang PH. Unusual upper gastrointestinal bleeding following radiofrequency ablation and transarterial chemoembolization for hepatocellular carcinoma. J Postgrad Med 2023; 69:237-238. [PMID: 36861547 PMCID: PMC10846808 DOI: 10.4103/jpgm.jpgm_764_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/15/2021] [Accepted: 12/09/2021] [Indexed: 02/25/2023] Open
Affiliation(s)
- CW Chang
- Department of Internal Medicine, Center for Digestive Medicine, China Medical University Hospital, Taichung, Taiwan
| | - HW Wang
- Department of Internal Medicine, Center for Digestive Medicine, China Medical University Hospital, Taichung, Taiwan
| | - WH Huang
- Department of Internal Medicine, Center for Digestive Medicine, China Medical University Hospital, Taichung, Taiwan
| | - PH Chuang
- Department of Internal Medicine, Center for Digestive Medicine, China Medical University Hospital, Taichung, Taiwan
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Hepatocellular Carcinoma with Gastrointestinal Involvement: A Systematic Review. Diagnostics (Basel) 2022; 12:diagnostics12051270. [PMID: 35626424 PMCID: PMC9140172 DOI: 10.3390/diagnostics12051270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/15/2022] [Accepted: 05/15/2022] [Indexed: 01/27/2023] Open
Abstract
In this paper, we aimed to evaluate clinical and imagistic features, and also to provide a diagnostic algorithm for patients presenting with gastrointestinal involvement from hepatocellular carcinoma (HCC). We conducted a systematic search on the PubMed, Scopus and Web of Science databases to identify and collect papers oncases of HCC with gastrointestinal involvement. This search was last updated on 29 April 2022. One hundred and twenty-three articles were included, corresponding to 197 patients. The majority of the patients were male (87.30%), with a mean age of 61.21 years old. The analysis showed large HCCs located mainly in the right hepatic lobe, and highly elevated alfa-fetoprotein (mean = 15,366.18 ng/mL). The most frequent etiological factor was hepatitis B virus (38.57%). Portal vein thrombosis was present in 27.91% of cases. HCC was previously treated in most cases by transarterial chemoembolization (32.99%) and surgical resection (28.93%). Gastrointestinal lesions, developed mainly through direct invasion and hematogenous routes, were predominantly detected in the stomach and duodenum in equal measure—27.91%. Gastrointestinal bleeding was the most common presentation (49.74%). The main diagnostic tools were esophagogastroduodenoscopy (EGD) and computed tomography. The mean survival time was 7.30 months. Gastrointestinal involvement in HCC should be included in the differential diagnosis of patients with underlying HCC and gastrointestinal manifestations or pathological findings in EGD.
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Hepatic artery pseudo-aneurysm rupturing into hepato-gastric fistula, a rare cause of massive upper gastrointestinal hemorrhage: Case report. Radiol Case Rep 2021; 17:133-136. [PMID: 34820036 PMCID: PMC8601960 DOI: 10.1016/j.radcr.2021.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 10/10/2021] [Indexed: 11/21/2022] Open
Abstract
Hepatic artery pseudo-aneurysm and hepato-fastric fistula are extremely rare clinical entities, which can be caused as complications of amoebic liver abscess. Herein, we report a 45- year old man, who presented with history of hematemesis since last 1 day, melena since last 3 days and fever since last 5 days. On physical examination, he was hemodynamically stable, pallor was noted. Abdominal examination revealed tenderness over the right-upper quadrant. Per-rectal examination showed evidences of melena. Esophagogastroduodenoscopy revealed stomach communicating anteriorly with the abscess cavity from the surrounding, possibly from liver. There was no evidence of fresh bleed during the procedure. The abscess was drained and sent for microbiological evaluation. Computed tomographic angiography revealed a well defined saccular outpouching arising from common hepatic artery with surrounding ill-defined hypodensity around segment V and IVb of liver. Patient underwent transfemoral endovascular coil embolization. Post embolisation, DSA showed complete occlusion of pseudo-aneurysm. He was discharged on oral metronidazole and was doing well on 8-month follow-up with no episodes of rebleed.
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Mimery A, Ramly N, Das A, Rajkomar K. Malignant hepatogastric fistula with associated secondary liver abscess: a rare complication of an occult gastric adenocarcinoma. BMJ Case Rep 2021; 14:14/8/e240238. [PMID: 34353824 PMCID: PMC8719141 DOI: 10.1136/bcr-2020-240238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 73-year-old woman presented with fever and right flank pain. The admission was complicated by sepsis, myocardial ischaemia and an upper gastrointestinal bleed. A gastroscopy eventually demonstrated a large antral adenocarcinoma. Further imaging showed no evidence of metastasis, but demonstrated a large segment 3 hepatic abscess. At laparotomy, a hepatogastric fistula (HGF) was noted and a synchronous subtotal gastrectomy and left lateral liver sectionectomy was performed. Final histology showed complete resection of the gastric cancer (T4bN2) and confirmed the presence of the fistula. The patient was discharged 10 days later. She passed away 6 months later with local recurrence, hepatic and pulmonary metastasis. We include a review summarising the other causes of HGF in the literature.
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Affiliation(s)
- Alexander Mimery
- Surgery, Rockhampton Hospital, Rockhampton, Queensland, Australia
| | - Nicolas Ramly
- Upper Gastrointestinal Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Amitabha Das
- Upper Gastrointestinal Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Kheman Rajkomar
- Upper Gastrointestinal Surgery, Bankstown Hospital, Sydney, New South Wales, Australia
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Upper Gastrointestinal Bleed Due to Invasive Hepatocellular Carcinoma and Hepato-Gastric Fistula. J Clin Exp Hepatol 2018; 8:104-105. [PMID: 29743802 PMCID: PMC5938330 DOI: 10.1016/j.jceh.2017.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 09/27/2017] [Indexed: 12/12/2022] Open
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Li L, Zhang WH, Meng FP, Ma XM, Shen LJ, Jin B, Li HW, Han J, Zhou GD, Liu SH. Gastric Metastasis of Hepatocellular Carcinoma With Gastrointestinal Bleeding After Liver Transplant: A Case Report. Transplant Proc 2016; 47:2544-7. [PMID: 26518968 DOI: 10.1016/j.transproceed.2015.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 09/02/2015] [Indexed: 01/20/2023]
Abstract
Gastrointestinal (GI) metastasis of hepatocellular carcinoma is very rare. This is the first report of post-transplantation gastric metastasis. A 43-year-old man with a history of hepatitis B-related hepatocellular carcinoma (HCC) in the right anterior segment of the liver received an orthotopic liver transplant. Three months after the transplantation, pulmonary metastasis was found by chest computed tomography, and he received 1 course of gamma knife treatment. He complained of melena with anemia 17 months post liver transplantation. Abdominal CT scan showed new occupying lesions in the liver and a mass in the stomach and around the spleen with embolus in the splenic vein. Endoscopy revealed a large irregular cauliflower-like mass in fundus with ulceration and bleeding on the surface. He received symptomatic treatment, but died of cancer-related bleeding 4 months later. GI bleeding may due to gastric metastasis after liver transplantation.
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Affiliation(s)
- L Li
- Liver Cirrhosis Treatment Center, 302 Military Hospital of China, Beijing, China
| | - W H Zhang
- Liver Cirrhosis Treatment Center, 302 Military Hospital of China, Beijing, China
| | - F P Meng
- Liver Cirrhosis Treatment Center, 302 Military Hospital of China, Beijing, China
| | - X M Ma
- Liver Cirrhosis Treatment Center, 302 Military Hospital of China, Beijing, China
| | - L J Shen
- Liver Cirrhosis Treatment Center, 302 Military Hospital of China, Beijing, China
| | - B Jin
- Liver Cirrhosis Treatment Center, 302 Military Hospital of China, Beijing, China
| | - H W Li
- Liver Cirrhosis Treatment Center, 302 Military Hospital of China, Beijing, China.
| | - J Han
- Liver Cirrhosis Treatment Center, 302 Military Hospital of China, Beijing, China
| | - G D Zhou
- Department of Pathology, 302 Military Hospital of China, Beijing, China
| | - S H Liu
- Department of Pathology, 302 Military Hospital of China, Beijing, China
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Pawar SV, Zanwar VG, Gambhire PA, Mohite AR, Choksey AS, Rathi PM, Asgaonkar DS. Unusual complication of amebic liver abscess: Hepatogastric fistula. World J Gastrointest Endosc 2015; 7:916-919. [PMID: 26240693 PMCID: PMC4515426 DOI: 10.4253/wjge.v7.i9.916] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 12/27/2014] [Accepted: 05/28/2015] [Indexed: 02/05/2023] Open
Abstract
Amebic liver abscess is a parasitic disease which is often encountered in tropical countries. A hepatogastric fistula secondary to an amebic liver abscess is a rare complication of this disease and there are only a handful of reported cases in literature. Here we present a case of an amebic liver abscess which was complicated with the development of a hepatogastric fistula. The patient presented with the Jaundice, pain and distension of abdomen. The Jaundice and pain improved partially after he had an episode of brownish black colored increase in frequency of stools for 5 to 6 d. Patient also had ascites and anemia. He was a chronic alcohol drinker. Esophagogastroduodenoscopy performed in view of the above findings. It showed a fistulous opening with bilious secretions along the lesser curvature of the stomach. On imaging multiple liver abscesses seen including one in sub capsular location. The patient was managed conservatively with antiamebic medications along with proton pump inhibitors. The pigtail drainage of the sub capsular abscess was done. The patient improved significantly. The repeat endoscopy performed after about two months showed reduction in fistula size. A review of the literature shows that hepatogastric fistulas can be managed conservatively with medications and drainage, endoscopically with biliary stenting or with surgical excision.
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Gandham VS, Pottakkat B, Panicker LC, Hari RV. Hepatogastric fistula: a rare complication of pyogenic liver abscess. BMJ Case Rep 2014; 2014:bcr-2014-204175. [PMID: 25035445 DOI: 10.1136/bcr-2014-204175] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Hepatogastric fistula is very rare. We report a case of hepatogastric fistula as a complication of pyogenic liver abscess. A 40-year-old man presented with upper abdominal pain and high-grade fever of 2 weeks. Evaluation revealed multiple liver abscesses. On an empirical diagnosis of pyogenic liver abscess, he was treated with antibiotics. During hospital stay he developed intermittent large quantity bilious vomiting. Gastroduodenoscopy and contrast-enhanced CT of the abdomen showed rupture of left lobe liver abscess into the stomach. As expectant management failed to resolve the abscess, endoscopic retrograde papillotomy and stenting of common bile duct was performed. After endoscopic stenting, symptoms subsided. Imaging repeated after 2 weeks of endoscopic stenting showed resolving abscess. He was discharged and is doing well on regular follow-ups. We conclude that hepatogastric fistula can be managed by endoscopic stenting as bile flow through the stent hastens resolution and healing of the fistula.
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Affiliation(s)
| | - Biju Pottakkat
- Department of Surgical Gastroenterology, JIPMER, Puducherry, India
| | - Lakshmi C Panicker
- Department of Medical Gastroenterology, SUT Hospital, Thiruvananthapuram, Kerala, India
| | - Ranjit Vijaya Hari
- Department of Surgical Gastroenterology, SUT Hospital, Thiruvananthapuram, Kerala, India
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Jeon J, Ahn J, Yoo H, Park TK, Je D, Jeong H, Lee KH. Hepatoduodenal fistula formation following transcatheter arterial chemoembolization and radiotherapy for hepatocellular carcinoma: treatment with endoscopic Histoacryl injection. Korean J Intern Med 2014; 29:101-5. [PMID: 24574839 PMCID: PMC3932379 DOI: 10.3904/kjim.2014.29.1.101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 06/26/2012] [Accepted: 06/29/2012] [Indexed: 02/08/2023] Open
Abstract
A 71-year-old male patient was readmitted to our hospital 1 month after discharge because of relapse of abdominal pain. He had been diagnosed with hepatocellular carcinoma (HCC) 1 year prior and had undergone repeated transcatheter arterial chemoembolization and radiotherapy. During the last hospitalization, he was diagnosed with a liver abscess complicated by previous treatments for HCC and was treated with intravenous antibiotics and abscess aspiration. Follow-up abdominal computed tomography revealed a liver abscess with a duodenal fistula, which was successfully treated with endoscopic Histoacryl injection into the fistula. Liver abscesses with duodenal fistulas rarely occur, but they are intractable and possibly fatal in patients with HCC. In the literature, they have frequently been managed only with abscess treatment without fistula management. We herein report the first case of a patient with a liver abscess complicated by a fistula between the duodenum and the abscess, which was treated with endoscopic Histoacryl injection.
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Affiliation(s)
- Jaryong Jeon
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joonseong Ahn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hongseok Yoo
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taek Kyu Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dongmo Je
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyemin Jeong
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Hyuck Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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