Selective Transcatheter Hepatic Arterial Chemoembolization for Hemobilia from Hepatocellular Carcinoma: Report of Three Cases

Abstract

0 SCVIR, 1999 WE present the clinical and radiological features in three cases of advanced hepatocellular carcinoma (HCC) that ruptured into the biliary system and caused hemobilia. Abrupt epigastric pain, melena, and jaundice were the symptoms, and the liver profile deteriorated after the onset of hemobilia. Computed tomography (CT) and endoscopic retrograde cholangiography (ERC) were useful in diagnosing hemobilia and localizing the bleeding sites. Transcatheter hepatic arterial chemoembolization (TACE) was selectively performed in the arteries feeding the ruptured HCCs. Hemobilia was well controlled and liver function improved after TACE. All patients were discharged within 25 days :fter the procedure. Although hemob;lia recurred a t 2 and 3 months after TACE in two patients, selective TACE again succeeded in controlling the bleeding in one patient. The patients died a t 2, 3, and 25 months after TACE. Bile duct invasion has been reported to be rare in patients with HCC (1). When HCC invades the biliary tree, the clinical features are characterized by obstructive jaundice and hemobilia due to rupture of the tumor into the biliary system. Hemobilia secondary to ruptured HCC is considered to be a terminal event, leading to the rapid death of the patient (2). However, effective treatments for hemobilia have not been established. Although hepatectomy seems to be the effective treatment, most patients are not candidates for surgery because they have advanced HCC (2-4). TACE is a useful treatment for intraperitoneal hemorrhage secondary to ruptured HCC (5). However, the appearance of hyperbilirubinemia that is frequently seen in patients with hemobilia is a significant poor prognostic factor. In this report, we present the clinical and radiologic features in three cases of HCC that ruptured into the biliary system and evaluate the clinical usefulness of selective TACE in controlling hemobilia.