Nishida Kazuhiro, Lefor Alan Kawarai, Funabiki Tomohiro
Department of Emergent and Critical Care Medicine, Saiseikai Yokohamashi Tobu Hospital, 3-6-1, Shimosueyoshi, Tsurumi, Yokohama-city, Kanagawa 230-8765, Japan.
Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
Case Reports Hepatol. 2018 Jun 4;2018:4576276. doi: 10.1155/2018/4576276. eCollection 2018.
Transarterial chemoembolization (TACE) is the first-line therapy for patient with unresectable hepatocellular carcinoma (HCC). Although TACE is a generally safe procedure, major complications can be occurred. We describe a patient with rupture of HCC after TACE followed by gastric bleeding.
An 81-year-old man presented with worsening epigastric pain. He had been diagnosed with multiple HCC with nonalcoholic steatohepatitis and underwent TACE 19 days previously. A contrast enhanced computed tomography (CT) scan of the abdomen showed rupture of an HCC. He was treated nonoperatively and discharged on hospital day 18. Five weeks after TACE, he was emergently admitted with massive hematochezia and shock. A contrast enhanced CT scan demonstrated extrinsic gastric compression by an HCC lesion with extravasation of contrast into the stomach. Emergent upper gastrointestinal endoscopy showed a bleeding gastric ulcer with extraluminal compression which was successfully controlled by hypertonic saline-epinephrine injection. Due to tumor progression, he was discharged for palliative care and died six weeks after TACE.
Rupture of HCC is a life-threatening complication after TACE with mortality rates up to 50%. After treatment of a ruptured HCC, extragastric compression and bleeding can occur due to direct compression by a primary lesion or intraperitoneal dissemination.
经动脉化疗栓塞术（TACE）是不可切除肝细胞癌（HCC）患者的一线治疗方法。尽管TACE通常是一种安全的手术，但仍可能发生严重并发症。我们描述了一名TACE术后发生HCC破裂并伴有胃出血的患者。
一名81岁男性因上腹部疼痛加重就诊。他被诊断为患有多种HCC合并非酒精性脂肪性肝炎，并于19天前接受了TACE治疗。腹部增强计算机断层扫描（CT）显示一个HCC破裂。他接受了非手术治疗，并于住院第18天出院。TACE术后五周，他因大量便血和休克紧急入院。增强CT扫描显示一个HCC病变对胃造成外在压迫，造影剂渗入胃内。紧急上消化道内镜检查显示一个有腔外压迫的出血性胃溃疡，通过高渗盐水-肾上腺素注射成功控制了出血。由于肿瘤进展，他出院接受姑息治疗，并于TACE术后六周死亡。
HCC破裂是TACE术后一种危及生命的并发症，死亡率高达50%。HCC破裂治疗后，由于原发病变的直接压迫或腹膜内播散，可能会发生胃外压迫和出血。
