ORCID (Optional)

Patrick Twohig: ORCID: 0000-0002-5423-8749

Erin Walsh: ORCID: 0000-0002-6824-0604

Amy Calderon: ORCID: 0009-0009-1187-9595

Document Type

Case Report


Digestive System | Digestive System Diseases | Higher Education | Medicine and Health Sciences | Neoplasms


Direct invasion of hepatocellular carcinoma (HCC) into the duodenum is a unique and life-threatening complication of HCC that has been rarely reported. A 60-year-old male with known HCC and cirrhosis presented with melena. Computed tomography of the abdomen and pelvis showed a 7cm hepatic mass abutting the duodenum. Esophagogastroduodenoscopy demonstrated a large, actively oozing mass in the duodenum treated with Hemospray® followed by transarterial embolization (TAE). Active upper gastrointestinal bleeding due to duodenal invasion of HCC can be successfully treated with Hemospray® Endoscopic Hemostat and TAE.




Hepatocellular carcinoma; gastrointestinal bleeding; duodenal invasion; embolization; Hemospray®

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Figure 1.jpeg (57 kB)
Coronal (left) and axial (right) Computed tomography (CT) of the abdomen and pelvis showing 7.3 cm segment IV HCC mass (blue arrows) eroding into the duodenum (yellow arrows) with associated mass effect and hemoperitoneum (red arrows).

Figure 2.jpeg (60 kB)
Esophagogastroduodenoscopy (EGD) showing a large mass with ulceration and a clot over it noted in the distal bulb/proximal sweep of the duodenum with active bleeding (black arrow).



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.