MAJOR UPPER GASTROINTESTINAL HEMORRHAGE ASSOCIATED WITH HEPATIC ARTERIAL CHEMOPERFUSION

Background: The present study reviews the nature of upper gastrointest inal complications of hepatic arterial chemoperfusion at a tertiary re ferral centre for the treatment of hepatic malignancy. Methods: The pa tients involved in the present study all had major upper gastrointesti nal (Gl) haemorrhage and were undergoing hepatic arterial chemoperfusi on. Results: Eight patients had major upper CI haemorrhage. Three of t hese 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 co mplications are probably caused by extravasation of 5-fluorouracil (5- FU) following thrombosis of the gastroduodenal artery. The resulting c avity may perforate into the hepatic artery, portal vein, duodenum or biliary tree. Surgeons and oncologists should be aware of these compli cations. If upper abdominal pain occurs, chemoperfusion should cease i mmediately and an urgent investigation, which may include catheter ang iography, gastroscopy and computed tomography (CT) scanning, should be carried out to exclude an hepatic artery pseudo-aneurysm.