Hepatocellular Carcinoma Presenting with Castrointestinal Bleeding Following Duodenal Invasion by the Tumor: Report of a Case

肝細胞癌侵犯、貫穿十二指腸合併胃腸道出血：一病例報告

溫義輝(Yih-Huei Uen) ； 許銘仁(Ming-Juen Sheu) ； 林靖南(Ching-Nan Lin) ； 梁安億(An-I Liang)

《中華民國消化系醫學雜誌》 18卷4期 (2001/12) Pp. 253-260

https://doi.org/10.6557/GJTb.200112_18(4).0002

摘要

肝細胞癌患者併發上胃腸道出血的原因多數是由於胃或食道靜脈曲張破裂出血；因為肝癌細胞侵犯胃腸道引起出血之情形較少見。本病例為一位47歲男性非B型肝炎帶原且無C型肝炎病毒抗體者，因上胃腸道出血入院，經電腦斷層、上消化道X光及內視鏡切片檢查，證實為肝細胞癌侵犯、貫穿十二指腸合併出血。剖腹手術切除後，病患存活兩年，無肝腫瘤復發及上胃腸道再出血情形，終因右側腎上腺轉移併敗血症死亡。

關鍵字

肝細胞癌 ； 胃腸道出血 ； 十二指腸侵犯

並列摘要

A 47-year-old man was admitted to our hospital due to upper gastrointestinal bleeding. Endoscopy revealed a large protruding mass with mucosal ulceration and bleeding over the second portion of the duodenum. Abdominal computed tomographic scan revealed a heterogenous tumor extending from the right lobe of the liver and encroaching on the duodenal wall. A diagnosis of metastatic hepatocellular carcinoma of the duodenum was made after an endoscopic biopsy. Partial hepatectomy and Whipple's procedure were performed. The patient's postoperative course was uneventful. Tissue pathology revealed an extensive primary hepatic tumor which had caused an ulcer in the second part of the duodenum and then protruded into the lumen. The patient survived another two years with no recurrence of hepatic lesion or bleeding and died of sepsis after metastasis to the right adrenal gland which was first noted at 18 months postoperatively. The presentation of hepatocellular carcinoma as upper gastrointestinal bleeding following duodenal perforation by the tumor through the bed of a large duodenal ulcer is quite unusual.

並列關鍵字

hepatocellular carcinoma ； gastrointestinal bleeding ； duodenal invasion