Upper GI bleeding – a rare complication occurring after PEIT

The most frequent complications after PEIT for HCC are represented by pain and fever after therapy and seldom hemorrhagic complications or tumor seeding.

An extremely rare complication, which was recently reported in a few cases, is represented by the occurrence of a severe upper GI bleeding within hours after ethanol injection in the hepatic tumor.

We present the case of a 78 years old patient with chronic HCV hepatopathy since 2004, and a 4/3.5cm right liver lobe HCC since 2007, presenting upper GI bleeding after PEIT due to severe gastric and duodenal lesions.

In this patient a single PEIT session was performed with the injection of 20ml of ethanol.

A few hours after ethanol injection the patient presented intense and persistent abdominal pain, followed the next day by “coffee-ground“ vomissments for witch he underwent gastroscopy showing two large ulcers (in antrum and duodenum), both covered with fibrin and hematin.

8 days after the ethanol injection the patient was discharged at his own request.

Discussions: Gastric lesions following PEIT is a very rare complication, that was reported only in four cases in the literature until now. The involvement of vascular mechanism is explained by the presence of a particular pattern of the arterial hepatic vascularisation.

Also the ethanol quantity and the speed of injection can be involved in the occurrence of this complication.