Abstract
Our purpose was to determine, in a prospective study, the causes of gastrointestinal hemorrhage in patients with hepatocellular carcinoma, and the relationship of portal vein invasion with variceal hemorrhage in these patients. During an 11-month period, 55 patients presented with hepatocellular carcinoma presented with signs and/or symptoms of upper gastrointestinal hemorrhage. Forty-seven percent had bleeding from varices, whereas the majority, 53%, had a nonvariceal bleeding source. Among those with nonvariceal bleeding, duodenal ulceration was the commonest cause. Direct tumor invasion into the gastrointestinal tract was found in three patients. Tumor invasion of the portal venous system was detected by ultrasound examination in 76% of the variceal bleeders, compared to only 45% of the nonvariceal bleeders. Despite the very high frequency of cirrhosis among patients with hepatocellular carcinoma, the source of bleeding was variceal in less than half of the patients. Portal vein invasion is a risk factor for subsequent variceal bleed.
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References
Hong Kong Cancer Registry 1990 Annual Statistical Report. Hospital Authority: October, 1993
Shiu W, Dewar G, Leung N, Leung WT, Chan M, Tao M, Lui C, Chan CL, Lau WY, Metreweli C, Li AKC: Hepatocellular carcinoma in Hong Kong: Clinical study on 340 cases. Oncology 47:241–245, 1990
Ho J, Wu PC, Kung TM: An autopsy study of hepatocellular carcinoma in Hong Kong. Pathology 13:409–416, 1981
Terblanche J, Burroughs AK, Hobbs KEF: Controversies in the management of bleeding oesophageal varices. N Engl J Med 320:1393–1398, 1989
Pinto HC, Abrantes A, Esteves AV, Almeida H, Pinto Correia JP: Long term prognosis of patients with cirrhosis of the liver and upper gastrointestinal bleeding. Am J Gastroenterol 84(10):1239–1243, 1989
Dave P, Rowen J, Messer J: Upper gastrointestinal bleeding in patients with portal hypertension: A reappraisal. J Clin Gastroenterol 5(2):113–115, 1983
Humbert P, Sarmiento J, Boix J, Planas R, Quintero E, Franquet T, Villagrasa M: Hepatocellular carcinoma presenting with bleeding due to duodenal perforation by the tumor. Endoscopy 19(1):37–38, 1987
Saito A, Yamamoto S, Ideguchi S, Kojoh K, Takatori K, Saito I, Yamamoto R, Ohmoto K, Ohumi T, Hino K, et al: A case of hepatocellular carcinoma (HCC) with bleeding due to duodenal perforation by the tumor. Gau No Rinsho 35(15):1785–1790, 1989
Fisher ER, Creed DL: Clot formation in the common bile duct. An unusual manifestation of primary heptic carcinoma. AMA Arch Surg 73:261–265, 1956
Hashizume M, Inokuchi K, Beppa K, Koyanagi N, Nagamine K, Sugimachi K, Hirose S: The natural history of non-alcoholic cirrhosis. Gastroenterol Jpn 19(5):430–435, 1984
Akiba M, Fjuita Y, Takahashi H: Clinical significance of tumour thrombosis of portal vein in hepatocellular carcinoma. Jikeikai Med J 30:197–206, 1983
Ng WD, Chan YT, Ho KK, Kong CK: Injection sclerotherapy for bleeding oesophageal varices in cirrhotic patients with hepatocellular carcinoma. Gastrointest Endosc 35(1):69–70, 1989
Arakawa M, Koga M, Kaye M: Pathomorphological study on primary liver cancers—relationship between tumor thrombus of portal vein and oesophageal varices. Kanzo Acta Hepatol. Jpn. 20:941–947, 1979
Ihde DC, Sherlock P, Winawer SJ, Fortner JG: Clinical manifestations of hepatoma. Am J Med 56:83–91, 1974
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Yeo, W., Sung, J.Y., Ward, S.C. et al. A prospective study of upper gastrointestinal hemorrhage in patients with hepatocellular carcinoma. Digest Dis Sci 40, 2516–2521 (1995). https://doi.org/10.1007/BF02220435
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DOI: https://doi.org/10.1007/BF02220435