title: Major upper gastrointestinal haemorrhage associated with hepatic arterial chemoperfusion.
abstract: BACKGROUND
  The present study reviews the nature of upper gastrointestinal complications of hepatic arterial chemoperfusion at a tertiary referral centre for the treatment of hepatic malignancy.
  
  
  METHODS
  The patients involved in the present study all had major upper gastrointestinal (GI) haemorrhage and were undergoing hepatic arterial chemoperfusion.
  
  
  RESULTS
  Eight patients had major upper GI haemorrhage. Three of these patients were not referred for surgical management, and all three patients died. The five patients who were admitted or transferred to our unit and who underwent surgery all survived.
  
  
  CONCLUSIONS
  These complications are probably caused by extravasation of 5-fluorouracil (5-FU) following thrombosis of the gastroduodenal artery. The resulting cavity may perforate into the hepatic artery, portal vein, duodenum or biliary tree. Surgeons and oncologists should be aware of these complications. If upper abdominal pain occurs, chemoperfusion should cease immediately and an urgent investigation, which may include catheter angiography, gastroscopy and computed tomography (CT) scanning, should be carried out to exclude an hepatic artery pseudo-aneurysm.
authors.affiliation: University of New South Wales Department of Surgery, Kogarah, Sydney, Australia.
authors.forename: W B
authors.initials: WB
authors.lastname: Ross
authors.forename: D L
authors.initials: DL
authors.lastname: Morris
authors.forename: P R
authors.initials: PR
authors.lastname: Clingan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology; D004381:Duodenal Ulcer / Q000139:chemically induced / Q000150:complications; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects*; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000209:etiology* / Q000601:surgery; D006499:Hepatic Artery; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000009:adverse effects*; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000209:etiology
chemical_list: D005472:Fluorouracil