title: Massive and life-threatening upper gastrointestinal bleeding due to invasive hepatocellular carcinoma: A case report.
abstract: BACKGROUND
  The mean survival is less than 6 months in hepatocellular carcinoma (HCC) patients with extrahepatic metastasis. Gastrointestinal(GI) bleeding frequency due to HCC invasion is 0.05% to 2.0%, and may be fatal.
  
  
  METHODS
  We encountered a case of HCC with direct invasion to the gastrium that caused a life-threatening upper GI bleeding. Our patient was a 62 year old male who was a heavy smoker and drinker for almost 30 years. He had several upper GI bleeding episodes during the previous 6 months. Computed tomography (CT) revealed a 13cm liver tumour directly invading the gastrium. Partial hepatic resection and subtotal gastrectomy were performed. Unfortunately, the patient died at the intensive care unit postoperatively due to hepatic failure.
  
  
  CONCLUSIONS
  Although the prognosis of HCC that has invaded the gastrium is very poor due to the advanced stage of the disease, surgical resection may be a favourable treatment option for patients with a massive upper GI bleeding.
  
  
  CONCLUSIONS
  The incidence of patients with massive bleeding due to gastric invasion of HCC is low, and only a few cases have been reported in the literature. Our purpose while presenting this rare case is to increase the awareness about the issue.
authors.affiliation: General Surgery Dep., Okmeydanı Training Research Hospital, İstanbul, Turkey. Electronic address: semihhot@hotmail.com.
authors.forename: Semih
authors.initials: S
authors.lastname: Hot
authors.affiliation: General Surgery Dep., Okmeydanı Training Research Hospital, İstanbul, Turkey. Electronic address: metintesiltas@gmail.com.
authors.forename: Metin
authors.initials: M
authors.lastname: Yeşiltaş
authors.affiliation: General Surgery Dep., Okmeydanı Training Research Hospital, İstanbul, Turkey. Electronic address: berkgokcek@hotmail.com.
authors.forename: Berk
authors.initials: B
authors.lastname: Gökçek
authors.affiliation: General Surgery Dep., Okmeydanı Training Research Hospital, İstanbul, Turkey. Electronic address: seracettin_egin@hotmail.com.
authors.forename: Seracettin
authors.initials: S
authors.lastname: Eğin
authors.affiliation: Pathology Department, Okmeydanı Training Research Hospital, İstanbul, Turkey. Electronic address: selmaserhan@hotmail.com.
authors.forename: Selma
authors.initials: S
authors.lastname: Şengiz
keywords: Case report; Hepatocellular carcinoma; Surgery; Upper gastrointestinal bleeding