Hepatocellular carcinoma presenting with gastrointestinal bleeding

Bleeding from a hepatocellular carcinoma (HCC) directly invading the gastrointestinal tract is rare; however its prevalence is anticipated to increase along with advancement of multi-modality management of HCC. Herein, we report on two cases of HCC directly invading the stomach and the transverse colon, respectively, and presenting with gastrointestinal bleeding. Aggressive surgical resection was performed in both cases, and the former has survived disease free for 3 years which is the longest survival recorded in the literature. We suggest that, with strict patient selection, limited hepatectomy with en bloc resection of the involved gastrointestinal segment may prevent hemorrhagic episodes in patients.