@article{oai:nagasaki-u.repo.nii.ac.jp:00020249,
 author = {Urata, Megumi and Isomoto, Hajime and Shikuwa, Saburo and Osabe, Masayuki and Matsunaga, Keiichiro and Omagari, Katsuhisa and Mizuta, Yohei and Murase, Kunihiko and Tomita, Masato and Shimokawa, Isao and Murata, Ikuo and Kohno, Shigeru},
 issue = {3-4},
 journal = {Acta medica Nagasakiensia},
 month = {Dec},
 note = {Hemorrhage from hepatocellular carcinoma (HCC) directly invading the gastrointestinal tract is very rare. A 71-yearold man, who had been treated with transcatheter arterial embolization and percutaneous ethanol injection for HCC in the right hepatic lobe, presented with melena. Endoscopic examination showed a crater-like ulceration coated with blood clot in the duodenal bulb, and microscopic examination of a biopsy specimen from the duodenal lesion confirmed HCC. Abdominal computed tomography (CT) revealed that the HCC mass containing air-density invaded the duodenum. Recurrent bleeding continued from the lesion and the patient died of liver failure. Postmortem examination revealed massive HCC with hepatoduodenal fistula caused by direct tumor invasion into the duodenum., Acta medica Nagasakiensia. 2001, 46(3-4), p.59-62},
 pages = {59--62},
 title = {Hepatocellular Carcinoma with Direct Invasion to the Duodenal Bulb, Presenting with Gastrointestinal Bleeding},
 volume = {46},
 year = {2001}
}